Provider Demographics
NPI:1346307279
Name:KRADEL, PAUL FRANKLIN (ED D)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FRANKLIN
Last Name:KRADEL
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W STEPHEN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3242
Mailing Address - Country:US
Mailing Address - Phone:304-263-3788
Mailing Address - Fax:304-579-4503
Practice Address - Street 1:316 W STEPHEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3242
Practice Address - Country:US
Practice Address - Phone:304-263-3788
Practice Address - Fax:304-579-4503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV159103TC1900X
MD2202103TC1900X
WV22028103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163421000Medicaid