Provider Demographics
NPI:1699397356
Name:KRUPKA, DAVID JACOB (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JACOB
Last Name:KRUPKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 INDIAN ROCK
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4907
Mailing Address - Country:US
Mailing Address - Phone:845-368-0100
Mailing Address - Fax:845-368-3866
Practice Address - Street 1:26 INDIAN ROCK
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4907
Practice Address - Country:US
Practice Address - Phone:845-368-0100
Practice Address - Fax:845-368-3866
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0882181041C0700X, 103K00000X, 106H00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY088218OtherNYSED OFFICE OF PROFESSIONS