Provider Demographics
NPI:1689031114
Name:LUPIS, ALEXANDER ANTE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ANTE
Last Name:LUPIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MASSACHUSETTS AVE NW
Mailing Address - Street 2:APT 1221
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-5114
Mailing Address - Country:US
Mailing Address - Phone:202-870-2690
Mailing Address - Fax:202-333-3538
Practice Address - Street 1:4000 MASSACHUSETTS AVE NW
Practice Address - Street 2:APT 1221
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-5114
Practice Address - Country:US
Practice Address - Phone:202-870-2690
Practice Address - Fax:202-333-3538
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05660103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical