MEDICARE: JOSEPH KRIVOS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1184495814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH KRIVOS LLC

Provider Business Mailing Address
First Line	:	756 CARDINAL ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44303-2206
Country	:	US
Telephone Number	:	234-738-4554
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 CARDINAL ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44303-2206
Country	:	US
Telephone Number	:	234-738-4554
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	EVELYN GARLAND
Credential	:
Telephone Number	:	404-213-5329

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	04/08/2026

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