Provider Demographics
NPI:1487463980
Name:KRUPA, MATTHEW RYAN
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:KRUPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 COLUMBIA PIKE APT 415
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4524
Mailing Address - Country:US
Mailing Address - Phone:330-440-2206
Mailing Address - Fax:
Practice Address - Street 1:12007 SUNRISE VALLEY DR STE 120
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3460
Practice Address - Country:US
Practice Address - Phone:571-652-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health