Provider Demographics
NPI:1740047323
Name:PUPKOWSKI, DAGMARA E
Entity type:Individual
Prefix:MRS
First Name:DAGMARA
Middle Name:E
Last Name:PUPKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAGMARA
Other - Middle Name:E
Other - Last Name:BRZOSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6510 EMERALD DUNES DR APT 204
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2751
Mailing Address - Country:US
Mailing Address - Phone:860-990-4816
Mailing Address - Fax:
Practice Address - Street 1:2001 W BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-5003
Practice Address - Country:US
Practice Address - Phone:561-841-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health