Provider Demographics
NPI:1639658057
Name:MCCRONE, CHRISTINE LYNN (PHD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LYNN
Last Name:MCCRONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:LYNN
Other - Last Name:ROLLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:6140 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3821
Mailing Address - Country:US
Mailing Address - Phone:440-233-7232
Mailing Address - Fax:440-204-4315
Practice Address - Street 1:6140 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3821
Practice Address - Country:US
Practice Address - Phone:440-233-7232
Practice Address - Fax:440-204-4315
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
OHC.2103372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448826Medicaid