Provider Demographics
NPI:1912029075
Name:KULPA, STAVROULA (MED,CAGS, LMH)
Entity Type:Individual
Prefix:
First Name:STAVROULA
Middle Name:
Last Name:KULPA
Suffix:
Gender:F
Credentials:MED,CAGS, LMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JETHOL DR
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1948
Mailing Address - Country:US
Mailing Address - Phone:617-306-0560
Mailing Address - Fax:
Practice Address - Street 1:9 JETHOL DR
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1948
Practice Address - Country:US
Practice Address - Phone:508-306-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA398037103TS0200X
MA8043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA398037OtherEDUCATOR'S LICENSE