Provider Demographics
NPI:1811223100
Name:KRACHENFELS, JOHN (PHD, LCSW-R, CASAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KRACHENFELS
Suffix:
Gender:M
Credentials:PHD, LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-2933
Mailing Address - Country:US
Mailing Address - Phone:516-567-4294
Mailing Address - Fax:
Practice Address - Street 1:445 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2606
Practice Address - Country:US
Practice Address - Phone:212-220-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5883101YA0400X
CT134511041C0700X
NY0438581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN