Provider Demographics
NPI:1508692153
Name:KRAUS, JOHNATHAN (PHD)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:KRAUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 WILLOW AVE # 2
Mailing Address - Street 2:
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1230
Mailing Address - Country:US
Mailing Address - Phone:323-974-3537
Mailing Address - Fax:
Practice Address - Street 1:662 WILLOW AVE # 2
Practice Address - Street 2:
Practice Address - City:GARWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07027-1230
Practice Address - Country:US
Practice Address - Phone:323-974-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty