Michael Kruepke

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

06757 Issued in MD

Practice address

29640 Three Notch Rd
Charlotte Hall, MD 20622-3244

Phone

(301) 884-7102

NPI assigned

Mar 8, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743897600000",
    "number": "1427643717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 BYARD LN",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "015812640",
            "telephone_number": "262-483-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29640 THREE NOTCH RD",
            "city": "CHARLOTTE HALL",
            "state": "MD",
            "postal_code": "206223244",
            "telephone_number": "301-884-7102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3409A Urbana Pike Ste 1C",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217047794",
            "country_code": "US",
            "telephone_number": "301-857-5187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRUEPKE",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-08",
        "last_updated": "2025-04-06",
        "certification_date": "2025-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3930-57",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "06757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Charlotte Hall, MD
• Providers in Charlotte Hall, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.