Provider Demographics
NPI:1356052773
Name:HUPALO, JUSTIN JOHN (AMFT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JOHN
Last Name:HUPALO
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5548
Mailing Address - Country:US
Mailing Address - Phone:510-388-4242
Mailing Address - Fax:
Practice Address - Street 1:2400 LISA LN
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3993
Practice Address - Country:US
Practice Address - Phone:510-846-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125867103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical