Healthcare Provider Details

I. General information

NPI: 1669203899
Provider Name (Legal Business Name): STEPHEN ANTHONY KRUWELL CDP00997 10/01/2026
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 ELMWOOD AVE
WARWICK RI
02888-2404
US

IV. Provider business mailing address

1990 ELMWOOD AVE
WARWICK RI
02888-2404
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-2700
  • Fax: 401-781-2790
Mailing address:
  • Phone: 401-781-2700
  • Fax: 401-781-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00997
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: