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General NPI Number Information
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NPI Number | 1972696664
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Entity Type | Individual
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Provider Name | ELLYN KRAVETTE MSW, CADC,CFAE,CEAP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 710 FRABLE RD
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-7718
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Country | US
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Telephone | 570-764-4706
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Fax |
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Provider Business Mailing Address
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Address Line | 710 FRABLE ROAD
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322
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Country | US
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Telephone | 570-764-4706
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 7786
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4776
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW012506L
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License Number State | PA
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