Provider Demographics
NPI:1669203899
Name:KRUWELL, STEPHEN ANTHONY (CDP00997 10/01/2026)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:KRUWELL
Suffix:
Gender:M
Credentials:CDP00997 10/01/2026
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-2404
Mailing Address - Country:US
Mailing Address - Phone:401-781-2700
Mailing Address - Fax:401-781-2700
Practice Address - Street 1:1990 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-2404
Practice Address - Country:US
Practice Address - Phone:401-781-2700
Practice Address - Fax:401-781-2790
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00997101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty