Provider Demographics
NPI:1821246315
Name:KRAVCHUCK, STEPHEN J (PSYD,)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:KRAVCHUCK
Suffix:
Gender:M
Credentials:PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-0211
Mailing Address - Country:US
Mailing Address - Phone:844-365-7676
Mailing Address - Fax:844-365-7676
Practice Address - Street 1:140 S. BROADWAY
Practice Address - Street 2:#7
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2417
Practice Address - Country:US
Practice Address - Phone:844-365-7676
Practice Address - Fax:844-365-7676
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00376500101YP2500X
NJ5004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional