Provider Demographics
NPI:1013779610
Name:KASTRAVA, KEVIN JAMES JR
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:KASTRAVA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOLLY DELL DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9318
Mailing Address - Country:US
Mailing Address - Phone:856-723-1583
Mailing Address - Fax:
Practice Address - Street 1:200 HOLLY DELL DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9318
Practice Address - Country:US
Practice Address - Phone:856-723-1583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)