Basic Information
Provider Information | |||||||||
NPI: | 1376993931 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DUPUIE | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | BSW, LLMSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5321 W BRIARCLIFF KNOLL DR | ||||||||
Address2: |   | ||||||||
City: | WEST BLOOMFIELD | ||||||||
State: | MI | ||||||||
PostalCode: | 483224117 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2488080727 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9315 TELEGRAPH RD | ||||||||
Address2: |   | ||||||||
City: | REDFORD | ||||||||
State: | MI | ||||||||
PostalCode: | 482391260 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3134504500 | ||||||||
FaxNumber: | 3134500004 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2016 | ||||||||
LastUpdateDate: | 03/01/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/01/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6851099659 | MI | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 6801099659 | 05 | MI |   | MEDICAID |