Provider Demographics
NPI:1144466764
Name:DOPULOS, VINCENT PETER (LPC)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:PETER
Last Name:DOPULOS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GROVE ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4051
Mailing Address - Country:US
Mailing Address - Phone:973-509-8373
Mailing Address - Fax:
Practice Address - Street 1:105 GROVE ST
Practice Address - Street 2:SUITE 12
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4051
Practice Address - Country:US
Practice Address - Phone:973-509-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00345900101YP2500X
221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist