Provider Demographics
NPI:1275025769
Name:KROMER, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KROMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 FISHCREEK RD UNIT 189
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4304
Mailing Address - Country:US
Mailing Address - Phone:330-382-2920
Mailing Address - Fax:
Practice Address - Street 1:516 WASHINGTON ST STE L
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4402
Practice Address - Country:US
Practice Address - Phone:440-600-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor