Individual
MS. MARY ALICE POUPON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
109 W 27TH ST RM 5S, NEW YORK, NY 10001-6208
(833) 351-8255
Mailing address
16 GEORGES HILL RD, NEWTOWN, CT 06470-1036
(203) 364-7000
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
002708
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
7903263
NY
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
002708
CT
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
7903263
NY
Other
Enumeration date
09/16/2013
Last updated
04/30/2025
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