Provider Demographics
NPI:1750154472
Name:DUPONT, RANDOLPH (PHD)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:DUPONT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 W WINDMILL LN STE 102&103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4420
Mailing Address - Country:US
Mailing Address - Phone:702-888-1340
Mailing Address - Fax:
Practice Address - Street 1:8390 W WINDMILL LN STE 102&103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4420
Practice Address - Country:US
Practice Address - Phone:702-888-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist