Provider Demographics
NPI:1104520980
Name:AMILIE M. DUBOIS, PSY.D., LLC
Entity type:Organization
Organization Name:AMILIE M. DUBOIS, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMILIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAPSTUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-929-7504
Mailing Address - Street 1:71 52ND SQ
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-2502
Mailing Address - Country:US
Mailing Address - Phone:312-929-7504
Mailing Address - Fax:
Practice Address - Street 1:71 52ND SQ
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-2502
Practice Address - Country:US
Practice Address - Phone:312-929-7504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty