Provider Demographics
NPI:1972696664
Name:KRAVETTE, ELLYN (MSW, CADC,CFAE,CEAP)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:KRAVETTE
Suffix:
Gender:F
Credentials:MSW, CADC,CFAE,CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 FRABLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322
Mailing Address - Country:US
Mailing Address - Phone:570-764-4706
Mailing Address - Fax:
Practice Address - Street 1:710 FRABLE RD
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7718
Practice Address - Country:US
Practice Address - Phone:570-764-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7786101YA0400X
PA4776101YA0400X
PASW012506L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker