Provider Demographics
NPI:1639203227
Name:KRAVITZ, RIKI (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:RIKI
Middle Name:
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1122
Mailing Address - Country:US
Mailing Address - Phone:612-822-1357
Mailing Address - Fax:612-822-1360
Practice Address - Street 1:1516 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2554
Practice Address - Country:US
Practice Address - Phone:612-822-1357
Practice Address - Fax:612-822-1360
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6253210OtherUBH
0G162KROtherBLUE CROSS BLUE SHIELD