Basic Information
Provider Information | |||||||||
NPI: | 1811223100 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KRACHENFELS | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSR-R, CASAC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 900 WASHINGTON RD | ||||||||
Address2: | CREDENTIALS OFFICE, KELLER ARMY COMMUNITY HOSPITAL | ||||||||
City: | WEST POINT | ||||||||
State: | NY | ||||||||
PostalCode: | 109961109 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8459387691 | ||||||||
FaxNumber: | 8459385770 | ||||||||
Practice Location | |||||||||
Address1: | 606 THAYER RD | ||||||||
Address2: | ASAP, WEST POINT MILITARY ACADEMY | ||||||||
City: | WEST POINT | ||||||||
State: | NY | ||||||||
PostalCode: | 109961700 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8459387691 | ||||||||
FaxNumber: | 8459385770 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/21/2009 | ||||||||
LastUpdateDate: | 10/21/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 5883 | NY | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 043858 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.