Healthcare Provider Details

I. General information

NPI: 1114979069
Provider Name (Legal Business Name): DAVID G KRAVETZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SUSANNA DR UNIT K203
DURHAM NC
27705-6747
US

IV. Provider business mailing address

4 SUSANNA DR UNIT K203
DURHAM NC
27705-6747
US

V. Phone/Fax

Practice location:
  • Phone: 919-599-0536
  • Fax: 919-443-1198
Mailing address:
  • Phone: 919-599-0536
  • Fax: 919-443-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1056
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: