Provider Demographics
NPI:1720595135
Name:DANIELS-KRAVITZ, LISA CAROLE (LPD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CAROLE
Last Name:DANIELS-KRAVITZ
Suffix:
Gender:F
Credentials:LPD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:CAROLE
Other - Last Name:KRAVITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:6929 W 130TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7878
Mailing Address - Country:US
Mailing Address - Phone:440-842-6867
Mailing Address - Fax:
Practice Address - Street 1:6929 W 130TH ST STE 500
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7878
Practice Address - Country:US
Practice Address - Phone:440-842-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.0700330OtherSTATE OF OHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND FAMILY THERAPIST BOARD