Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0777 | KY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0777 | KY |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 128195 | KY |
NPI | 1205814639 |
---|---|
Provider Name | Dr. Grace Mathai Kuravackel |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 23/10/2020 |