Provider Demographics
NPI:1780894139
Name:KROIN, LORETTA E (PHD)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:E
Last Name:KROIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3596
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-3596
Mailing Address - Country:US
Mailing Address - Phone:317-580-4000
Mailing Address - Fax:317-580-4005
Practice Address - Street 1:9292 N MERIDIAN ST
Practice Address - Street 2:SUITE 311
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1857
Practice Address - Country:US
Practice Address - Phone:317-580-4000
Practice Address - Fax:317-580-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040360103T00000X
IL071.008351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN315490Medicare UPIN