Healthcare Provider Details

I. General information

NPI: 1881314904
Provider Name (Legal Business Name): JOHN KREITZBERG MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CHESTNUT ST STE 304
PHILADELPHIA PA
19106-3059
US

IV. Provider business mailing address

123 CHESTNUT ST STE 304
PHILADELPHIA PA
19106-3059
US

V. Phone/Fax

Practice location:
  • Phone: 267-702-3570
  • Fax:
Mailing address:
  • Phone: 267-702-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC018213
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: