Healthcare Provider Details

I. General information

NPI: 1356140750
Provider Name (Legal Business Name): KYLE JOESPH KRAVETZ CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 STATE RD
CLEVELAND OH
44109-5244
US

IV. Provider business mailing address

1980 BROOKPARK RD
CLEVELAND OH
44109-5810
US

V. Phone/Fax

Practice location:
  • Phone: 440-468-6550
  • Fax: 440-848-8894
Mailing address:
  • Phone: 216-396-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.191617
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCDCA.191617
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: