MEDICARE: MR. MARTIN KENNETH KRAVCHICK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW013805	PA

General Provider Information

NPI Number	:	1356524458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN KENNETH KRAVCHICK LCSW

Provider Business Mailing Address
First Line	:	340 MONTAGE MOUNTAIN RD
Second Line	:
City	:	MOOSIC
State	:	PA
Zip	:	18507-1782
Country	:	US
Telephone Number	:	570-346-3686
Fax Number	:	570-346-5301

Provider Business Practice Location Address
First Line	:	908 NORTH ST
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-2216
Country	:	US
Telephone Number	:	570-760-0211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	11/18/2022

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Directions to “ MR. MARTIN KENNETH KRAVCHICK LCSW” Practice Location

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