Provider Demographics
NPI:1942463260
Name:KRAVITZ, JENA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENA
Middle Name:A
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22647 VENTURA BLVD STE 851
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1416
Mailing Address - Country:US
Mailing Address - Phone:818-804-8492
Mailing Address - Fax:310-756-1225
Practice Address - Street 1:4766 PARK GRANADA STE 202
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3341
Practice Address - Country:US
Practice Address - Phone:818-804-8492
Practice Address - Fax:310-756-1225
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21989103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist