Provider Demographics
NPI:1124174313
Name:KRATZ, KATHERINE MARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARY
Last Name:KRATZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 MARLOWE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4318
Mailing Address - Country:US
Mailing Address - Phone:216-226-4558
Mailing Address - Fax:
Practice Address - Street 1:5851 PEARL RD
Practice Address - Street 2:SUITE 305
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2112
Practice Address - Country:US
Practice Address - Phone:440-845-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5869103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2425272Medicaid
OH2425272Medicaid