Provider Demographics
NPI:1033681556
Name:LUPTOWSKI, KRISTINA ELISABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ELISABETH
Last Name:LUPTOWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:ELISABETH
Other - Last Name:MINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:2100 RAYBROOK ST SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5783
Mailing Address - Country:US
Mailing Address - Phone:616-235-5100
Mailing Address - Fax:
Practice Address - Street 1:2100 RAYBROOK ST SE STE 300
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5783
Practice Address - Country:US
Practice Address - Phone:616-235-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010906021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical