Active NPI
Edward Kravitz, PHD
- Clinical Psychologist
- Southbury, CT
National Provider Identifier
1295774321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 001751
- Practice address
- 30 Quaker Farms Rd
Southbury, CT 06488-2732 - Phone
- (203) 687-6429
- Fax
- (203) 687-6429
- NPI assigned
- Jun 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 001751 | CT | Primary |
Addresses
Primary practice location
30 Quaker Farms Rd
Southbury, CT 06488-2732
Mailing address
51 Hawley Ave
Milford, CT 06460-8113
Phone (203) 687-6429
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004136471 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001751 | CT | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medoptions Behavioral Health Assoc, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1295774321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 HAWLEY AVE",
"city": "MILFORD",
"state": "CT",
"postal_code": "064608113",
"telephone_number": "203-687-6429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 QUAKER FARMS RD",
"city": "SOUTHBURY",
"state": "CT",
"postal_code": "064882732",
"telephone_number": "203-687-6429",
"fax_number": "203-687-6429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRAVITZ",
"first_name": "EDWARD",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "001751",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004136471",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.