Provider Demographics
NPI:1053542373
Name:DUPUIS, TAMMY LYN (LMSW-CC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYN
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8348
Mailing Address - Country:US
Mailing Address - Phone:207-782-1922
Mailing Address - Fax:
Practice Address - Street 1:43 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-1403
Practice Address - Country:US
Practice Address - Phone:207-739-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC121491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical