Provider Demographics
NPI:1558453514
Name:KRAVITZ, JAMIE BRENT (LCPC LCADC)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:BRENT
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:LCPC LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10400 RIDGLAND ROAD
Mailing Address - Street 2:STE 1
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:410-628-6120
Mailing Address - Fax:410-628-9825
Practice Address - Street 1:10400 RIDGLAND ROAD
Practice Address - Street 2:STE 1
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030
Practice Address - Country:US
Practice Address - Phone:410-628-6120
Practice Address - Fax:410-628-9825
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA233101YA0400X
MDLC1169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
61922201OtherCAREFIRST MD
25830024OtherCAREFIRST GHMSI
216879OtherCOMPSYCH