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General NPI Number Information
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NPI Number | 1114979069
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Entity Type | Individual
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Provider Name | DAVID G KRAVETZ PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 5613 DURALEIGH RD STE 101
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City | RALEIGH
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State | NC
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Zip | 27612-2694
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Country | US
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Telephone | 919-599-0536
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Fax | 919-477-0283
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Provider Business Mailing Address
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Address Line | 5613 DURALEIGH RD STE 101
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City | RALEIGH
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State | NC
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Zip | 27612-2694
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Country | US
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Telephone | 919-599-0536
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Fax | 919-477-0283
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1056
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License Number State | NC
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