Provider Demographics
NPI:1205934585
Name:THOMAS D KRAFT PHD INC
Entity type:Organization
Organization Name:THOMAS D KRAFT PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DILLON
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-372-5883
Mailing Address - Street 1:1185 MILLIKIN PLACE NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4447
Mailing Address - Country:US
Mailing Address - Phone:330-372-5883
Mailing Address - Fax:
Practice Address - Street 1:280 N PARK AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1109
Practice Address - Country:US
Practice Address - Phone:330-392-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2511103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329639Medicaid
OH00692688000OtherWORKERS COMP
KRCP02451Medicare ID - Type Unspecified