Provider Demographics
NPI:1740543487
Name:KRAVITZ, DEBORAH LARA (MSED)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LARA
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 RIVENDELL CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5334
Mailing Address - Country:US
Mailing Address - Phone:631-423-2727
Mailing Address - Fax:
Practice Address - Street 1:146 RIVENDELL CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-5334
Practice Address - Country:US
Practice Address - Phone:631-423-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1206959222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist