Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY 368 | HI |
NPI | 1043365448 |
---|---|
Provider Name | Dr. Richard J Kravetz |
First Address | Honolulu, HI 96825-3520 |
Second Address | Honolulu, HI 96825-3520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02439701 | (05) | HI |
02439702 | (05) | HI |