Provider Demographics
NPI:1346512175
Name:KROL, LUKASZ M (PSYD)
Entity Type:Individual
Prefix:
First Name:LUKASZ
Middle Name:M
Last Name:KROL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 RIDGEWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3542
Mailing Address - Country:US
Mailing Address - Phone:860-521-4899
Mailing Address - Fax:860-521-4858
Practice Address - Street 1:68 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST HATFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2430
Practice Address - Country:US
Practice Address - Phone:860-521-4899
Practice Address - Fax:860-521-4858
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical