Provider Demographics
NPI:1326372236
Name:MINDY KRUPP, LCSW-C, THERAPIST, LLC
Entity Type:Organization
Organization Name:MINDY KRUPP, LCSW-C, THERAPIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-434-8625
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-0915
Mailing Address - Country:US
Mailing Address - Phone:240-434-8625
Mailing Address - Fax:240-434-8625
Practice Address - Street 1:14350 SOLOMONS ISLAND ROAD
Practice Address - Street 2:SUITE 202B
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-9998
Practice Address - Country:US
Practice Address - Phone:240-434-8625
Practice Address - Fax:240-434-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherFEDERAL TAX ID