MEDICARE: DR. MEREDYTH D. KRAVITZ PSY.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	016448	NY

General Provider Information

NPI Number	:	1861656225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEREDYTH D. KRAVITZ PSY.D.

Provider Business Mailing Address
First Line	:	945 5TH AVE OFC 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2667
Country	:	US
Telephone Number	:	212-439-8430
Fax Number	:

Provider Business Practice Location Address
First Line	:	945 5TH AVE OFC 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2667
Country	:	US
Telephone Number	:	212-439-8430
Fax Number	:

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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