Provider Demographics
NPI:1710009196
Name:KRAWIC, EDMUND J (LCPC)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:J
Last Name:KRAWIC
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CHAPMAN ST.
Mailing Address - Street 2:P.O. BOX 21
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04555
Mailing Address - Country:US
Mailing Address - Phone:207-592-6968
Mailing Address - Fax:207-563-8829
Practice Address - Street 1:64 CHAPMAN
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04555
Practice Address - Country:US
Practice Address - Phone:207-592-6968
Practice Address - Fax:207-563-8829
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health