Provider Demographics
NPI:1275209066
Name:KRAMER, JOSEPH GOMEZ
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GOMEZ
Last Name:KRAMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2322
Mailing Address - Country:US
Mailing Address - Phone:501-339-4854
Mailing Address - Fax:
Practice Address - Street 1:415 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2322
Practice Address - Country:US
Practice Address - Phone:501-339-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2023-11-14
Deactivation Date:2021-12-30
Deactivation Code:
Reactivation Date:2022-02-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty