Provider Demographics
NPI:1609932904
Name:KRAVITZ, JEFFREY H (EDD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:YAACOV
Other - Middle Name:JEFFREY
Other - Last Name:KRAVITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:108 TOWANDA AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2932
Mailing Address - Country:US
Mailing Address - Phone:215-635-3011
Mailing Address - Fax:
Practice Address - Street 1:108 TOWANDA AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2932
Practice Address - Country:US
Practice Address - Phone:215-635-3011
Practice Address - Fax:215-635-3011
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005526L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA455808000OtherMAGELLAN MIS NUMBER
PA7035296Medicaid
PA455808000OtherMAGELLAN MIS NUMBER
PA7035296Medicaid