Healthcare Provider Details

I. General information

NPI: 1093603706
Provider Name (Legal Business Name): DAVID KRAUSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WINDRIM AVE
PHILADELPHIA PA
19141-2710
US

IV. Provider business mailing address

3617 MERRICK RD
PHILADELPHIA PA
19129-1614
US

V. Phone/Fax

Practice location:
  • Phone: 215-455-3900
  • Fax:
Mailing address:
  • Phone: 570-933-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: