Provider Demographics
NPI:1063854826
Name:LUPINETTI, MARY DIMOCK (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DIMOCK
Last Name:LUPINETTI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2684 KERRISDALE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5719
Mailing Address - Country:US
Mailing Address - Phone:541-842-0655
Mailing Address - Fax:541-292-5689
Practice Address - Street 1:11 TRIPP ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7343
Practice Address - Country:US
Practice Address - Phone:541-842-0655
Practice Address - Fax:541-292-5689
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500704770Medicaid