Provider Demographics
NPI:1548213747
Name:KRAMER, DONNA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2701
Mailing Address - Country:US
Mailing Address - Phone:631-369-7307
Mailing Address - Fax:631-369-7307
Practice Address - Street 1:21 W 2ND ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2701
Practice Address - Country:US
Practice Address - Phone:631-369-7307
Practice Address - Fax:631-369-7307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO45553-O1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4K601Medicare ID - Type UnspecifiedPROVIDER #