Provider Demographics
NPI:1003440587
Name:KRAVETZ, BRIAN ELI (PSYD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ELI
Last Name:KRAVETZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SPRUCE ST APT 35B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5225
Mailing Address - Country:US
Mailing Address - Phone:917-690-5240
Mailing Address - Fax:
Practice Address - Street 1:8 SPRUCE ST APT 35B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5225
Practice Address - Country:US
Practice Address - Phone:917-690-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002047-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health