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NPI Code Detail

MEDICARE: MRS. LISA CAROLE DANIELS-KRAVITZ LPD

MEDICARE: MRS. LISA CAROLE DANIELS-KRAVITZ LPD
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
1101YP2500XProfessional CounselorC.0700330OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C.0700330OTHEROHSTATE OF OHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND FAMILY THERAPIST BOARD

General Provider Information

NPI Number : 1720595135
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA CAROLE DANIELS-KRAVITZ LPD
Provider Business Mailing Address
First Line : 6929 W 130TH ST STE 500
Second Line :
City : PARMA HEIGHTS
State : OH
Zip : 44130-7878
Country : US
Telephone Number : 440-842-6867
Fax Number :
Provider Business Practice Location Address
First Line : 6929 W 130TH ST STE 500
Second Line :
City : PARMA HEIGHTS
State : OH
Zip : 44130-7878
Country : US
Telephone Number : 440-842-6867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2018
Last Update Date : 01/08/2018

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Directions to “ MRS. LISA CAROLE DANIELS-KRAVITZ LPD” Practice Location

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