Provider Demographics
NPI:1326105768
Name:KRUPITSKY, LYUDMILA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:KRUPITSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MILA
Other - Middle Name:
Other - Last Name:KRUPITSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2467 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-891-8686
Mailing Address - Fax:718-891-7911
Practice Address - Street 1:2467 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-891-8686
Practice Address - Fax:718-891-7911
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03331211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01397240Medicaid
NY1946Medicare PIN
NY01397240Medicaid