Provider Demographics
NPI:1750612693
Name:PUPELLO, PATRICIA LALA (LMHC, NCC, CRC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LALA
Last Name:PUPELLO
Suffix:
Gender:F
Credentials:LMHC, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 CLEARVIEW STREET
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629
Mailing Address - Country:US
Mailing Address - Phone:813-817-7598
Mailing Address - Fax:813-254-0109
Practice Address - Street 1:1056 CLEARVIEW STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629
Practice Address - Country:US
Practice Address - Phone:813-817-7598
Practice Address - Fax:813-254-0109
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC 6595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health