Provider Demographics
NPI:1477900165
Name:CROFT, AMANDA VALERIE (EDD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:VALERIE
Last Name:CROFT
Suffix:
Gender:F
Credentials:EDD, NCSP
Other - Prefix:DR
Other - First Name:MANDI
Other - Middle Name:
Other - Last Name:CROFT PETOSKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:365 N HALSTED ST APT 2502
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1378
Mailing Address - Country:US
Mailing Address - Phone:847-708-3004
Mailing Address - Fax:
Practice Address - Street 1:5250 OLD ORCHARD RD
Practice Address - Street 2:ALEXANDER J. PARET AND ASSOCIATES
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4460
Practice Address - Country:US
Practice Address - Phone:847-708-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2493229103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool