Provider Demographics
NPI:1588710339
Name:LUPOLI, AMY LYNN (MFT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:LUPOLI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:HOWLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:52 MOHAWK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4116
Mailing Address - Country:US
Mailing Address - Phone:203-376-9721
Mailing Address - Fax:
Practice Address - Street 1:3 WATROUS FARM RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2819
Practice Address - Country:US
Practice Address - Phone:203-376-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001483OtherSTATE OF CONNECTICUT LICENSE