Provider Demographics
NPI:1518582576
Name:KRUPNICK, ERIC C (RBT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:C
Last Name:KRUPNICK
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 PIERCE ST APT 17
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3859
Mailing Address - Country:US
Mailing Address - Phone:954-261-8973
Mailing Address - Fax:
Practice Address - Street 1:7113 THREE CHOPT RD # 301
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3643
Practice Address - Country:US
Practice Address - Phone:571-208-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116948106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician