Provider Demographics
NPI:1548920630
Name:KRUPKA, JOSHUA JOSEPH
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JOSEPH
Last Name:KRUPKA
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 1:4507 OLD POST RD.
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813
Mailing Address - Country:US
Mailing Address - Phone:401-364-7705
Mailing Address - Fax:
Practice Address - Street 1:4705 OLD POST RD UNIT A
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-1842
Practice Address - Country:US
Practice Address - Phone:401-364-7705
Practice Address - Fax:401-364-1982
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00897101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty