Provider Demographics
NPI:1912238551
Name:CROFOOT, JOYCE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ANN
Last Name:CROFOOT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:JOYCE
Other - Middle Name:ANN
Other - Last Name:CROFOOT-NEDELMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1151 DOVE STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2856
Mailing Address - Country:US
Mailing Address - Phone:949-660-0643
Mailing Address - Fax:949-263-8877
Practice Address - Street 1:1151 DOVE STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2856
Practice Address - Country:US
Practice Address - Phone:949-660-0643
Practice Address - Fax:949-263-8877
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11146103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist