Provider Demographics
NPI:1174189377
Name:KRONENGOLD, HENRY (PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:KRONENGOLD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W 86TH ST APT 11E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3664
Mailing Address - Country:US
Mailing Address - Phone:212-721-2436
Mailing Address - Fax:
Practice Address - Street 1:5 W 86TH ST APT 10B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3664
Practice Address - Country:US
Practice Address - Phone:212-721-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014233-1103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty