1184211021 NPI number — RAUL ZAMORA-DUPREY MSW, LCSW

Table of content: RAUL ZAMORA-DUPREY MSW, LCSW (NPI 1184211021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184211021 NPI number — RAUL ZAMORA-DUPREY MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAMORA-DUPREY
Provider First Name:
RAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
X

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZAMORA-DUPREY
Provider Other First Name:
ADVAITA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184211021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 S. COLLEGE RD., STE. 11
Provider Second Line Business Mailing Address:
PMB 2027
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-840-8981
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 N 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-343-0270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C016501 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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