Provider Demographics
NPI:1154405769
Name:KRAMER, JUDITH G (LICSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:KRAMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3713
Mailing Address - Country:US
Mailing Address - Phone:304-637-1002
Mailing Address - Fax:304-636-3829
Practice Address - Street 1:10 S RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3713
Practice Address - Country:US
Practice Address - Phone:304-637-1002
Practice Address - Fax:304-636-3829
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00080547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVKRSW22362Medicare ID - Type Unspecified