Provider Demographics
NPI:1487620811
Name:KRUPP, DOREEN MARIE (MED)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:MARIE
Last Name:KRUPP
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PONDSIDE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1146
Mailing Address - Country:US
Mailing Address - Phone:860-529-8600
Mailing Address - Fax:860-667-2408
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3038
Practice Address - Country:US
Practice Address - Phone:860-559-6557
Practice Address - Fax:860-667-2408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT00656101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300000656CT01OtherANTHEM
TX7794720OtherAETNA