Provider Demographics
NPI:1356140750
Name:KRAVETZ, KYLE JOESPH (CDCA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JOESPH
Last Name:KRAVETZ
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 BROOKPARK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-5810
Mailing Address - Country:US
Mailing Address - Phone:216-396-4565
Mailing Address - Fax:
Practice Address - Street 1:4705 STATE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5244
Practice Address - Country:US
Practice Address - Phone:440-468-6550
Practice Address - Fax:440-848-8894
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.191617251S00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health