Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1043671910 |
---|---|
Provider Name | Megan Dupras |
First Address | Fairhaven, MA 02719 |
Second Address | New Bedford, MA 02740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2016 |
Last Update Date | 18/03/2016 |