Provider Demographics
NPI:1467404509
Name:KVETON, ELLEN M (LCP)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:KVETON
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 BUSINESS PARK DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6533
Mailing Address - Country:US
Mailing Address - Phone:757-466-3336
Mailing Address - Fax:757-455-5750
Practice Address - Street 1:2470 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-539-1503
Practice Address - Fax:757-539-0107
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001893103TC0700X
VA810001893103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007702655Medicaid
VA086642Medicare UPIN
VA202864Medicare UPIN
VAMAMSIMedicare UPIN
VA541493432Medicare UPIN
VA264708000Medicare UPIN
VA007702655Medicaid
VA1006771Medicare UPIN