Provider Demographics
NPI:1639623077
Name:KRAVITZ, PAMELA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MEEHAN LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3033
Mailing Address - Country:US
Mailing Address - Phone:914-886-3439
Mailing Address - Fax:
Practice Address - Street 1:1 RABRO DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4270
Practice Address - Country:US
Practice Address - Phone:914-886-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-14
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist