Provider Demographics
NPI:1164778650
Name:KAVRAN, DENNIS (PSYS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:KAVRAN
Suffix:
Gender:M
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18045 BIRCH HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5825
Mailing Address - Country:US
Mailing Address - Phone:440-543-7819
Mailing Address - Fax:
Practice Address - Street 1:5000 ROCKSIDE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6823
Practice Address - Country:US
Practice Address - Phone:216-901-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP577103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool