Provider Demographics
NPI:1922174390
Name:KROTO, BROOKE H (LISW)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:H
Last Name:KROTO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1407
Mailing Address - Country:US
Mailing Address - Phone:216-701-0371
Mailing Address - Fax:216-261-1655
Practice Address - Street 1:250 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1407
Practice Address - Country:US
Practice Address - Phone:216-701-0371
Practice Address - Fax:216-261-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHI7140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW15912Medicare PIN
OHSW15911Medicare PIN