Provider Demographics
NPI:1386694784
Name:LUPATKIN, RICHARD WILLIAM (EDD, LMHC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:LUPATKIN
Suffix:
Gender:M
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 YORK TER
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2321
Mailing Address - Country:US
Mailing Address - Phone:617-739-1258
Mailing Address - Fax:617-232-4145
Practice Address - Street 1:233 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5017
Practice Address - Country:US
Practice Address - Phone:617-739-2052
Practice Address - Fax:617-232-4145
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1622101YM0800X
MA205659104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA198657OtherCOMPSYCH
MA2113677OtherCIGNA
7149365OtherAETNA
AL18191642Medicaid
MALM0119OtherBLUE CROSS BLUE SHIELD
MA383077OtherMAGELLAN
MA464217OtherVALUE OPTIONS
MA16412OtherUNITED BEHAVIORAL HEALTH