Provider Demographics
NPI:1326070194
Name:KROHNEMANN, KRISTINA E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:E
Last Name:KROHNEMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1895
Mailing Address - Street 2:
Mailing Address - City:MAPLETON DEPOT
Mailing Address - State:PA
Mailing Address - Zip Code:17052-9715
Mailing Address - Country:US
Mailing Address - Phone:814-542-7530
Mailing Address - Fax:814-542-2741
Practice Address - Street 1:RR 1 BOX 1895
Practice Address - Street 2:
Practice Address - City:MAPLETON DEPOT
Practice Address - State:PA
Practice Address - Zip Code:17052-9715
Practice Address - Country:US
Practice Address - Phone:814-542-7530
Practice Address - Fax:814-542-2741
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA814289NKAMedicare ID - Type UnspecifiedLCSW