Provider Demographics
NPI:1114192002
Name:KROMER, JONATHAN MILLER (LCSW, CSW-G)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MILLER
Last Name:KROMER
Suffix:
Gender:M
Credentials:LCSW, CSW-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1017
Mailing Address - Country:US
Mailing Address - Phone:704-302-9544
Mailing Address - Fax:704-302-9301
Practice Address - Street 1:4525 CAMERON VALLEY PKWY, 2ND FLOOR
Practice Address - Street 2:MECKLENBURG MEDICAL GROUP
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-302-9544
Practice Address - Fax:704-302-9301
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical