| Doctor Name: | MS. MARY ALICE POUPON |
| NPI Number: | 1073949509 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NPP |
| License Number: | 7903263 |
| Business Practice Address: | 23 Split Rock Rd Newtown, CT - 064702456 |
| Business Phone Number: | 2033647000 |
| Business Fax Number: | |
| Mailing Address: | 23 Split Rock Rd, NEWTOWN |
| State: | CT |
| Postal Code: | 064702456 |
| Phone Number: | 2033647000 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2013 |
| NPI Last Update Date: | 09/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 7903263 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |