Provider Demographics
NPI:1336199702
Name:KRAMER, DAYLE M
Entity Type:Individual
Prefix:MS
First Name:DAYLE
Middle Name:M
Last Name:KRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 BROADWAY
Mailing Address - Street 2:SUITE #1200
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:917-446-6442
Mailing Address - Fax:
Practice Address - Street 1:915 BROADWAY
Practice Address - Street 2:SUITE #1200
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:917-446-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1900143103TP0814X
NYR0509721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY600155Medicaid
11558440OtherUNIVERSAL PROVIDER NUMBER