Provider Demographics
NPI:1245737949
Name:KRAVITZ, JOHN M (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 LA MAR CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2516
Mailing Address - Country:US
Mailing Address - Phone:925-490-5569
Mailing Address - Fax:
Practice Address - Street 1:2940 CAMINO DIABLO STE 110
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94597-3983
Practice Address - Country:US
Practice Address - Phone:925-490-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist