=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598557621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRUPP PSYCHOLOGICAL SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2025
-----------------------------------------------------
Last Update Date | 05/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3177 LATTA RD # 165
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14612-3094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-204-0247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3177 LATTA RD # 165
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14612-3094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-204-0247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DR. MEGHAN BAUER KRUPP
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 585-204-0247
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------