MEDICARE: MR. KENT C. KRAVITZ 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	123170-3501	UT

General Provider Information

NPI Number	:	1669557245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENT C. KRAVITZ LCSW

Provider Business Mailing Address
First Line	:	2870 E 3300 S STE 5
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2847
Country	:	US
Telephone Number	:	801-485-0760
Fax Number	:	801-485-0963

Provider Business Practice Location Address
First Line	:	2870 E 3300 S STE 5
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2847
Country	:	US
Telephone Number	:	801-485-0760
Fax Number	:	801-485-0963

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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