Provider Demographics
NPI:1760780431
Name:KRASKY, DAVID LAWRENCE (PSYS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:KRASKY
Suffix:
Gender:M
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 EL DORADO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3217
Mailing Address - Country:US
Mailing Address - Phone:954-579-6949
Mailing Address - Fax:
Practice Address - Street 1:12401 ORANGE DR STE 224
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4343
Practice Address - Country:US
Practice Address - Phone:954-385-4696
Practice Address - Fax:954-385-8385
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS989101Y00000X
FLSS 989103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty