Provider Demographics
NPI:1952145732
Name:DUPONT, TROY ANTHONY JR
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:ANTHONY
Last Name:DUPONT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TROY
Other - Middle Name:ANTHONY
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 FAIRWAY DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:877-418-2978
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:4202 N. 1-10 SERVICE RD W METAIRIE, LA
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-475-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician