Healthcare Provider Details

I. General information

NPI: 1255286019
Provider Name (Legal Business Name): NICOLE KROENER AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 HAVEMEYER LN
REDONDO BEACH CA
90278-4716
US

IV. Provider business mailing address

1743 HAVEMEYER LN
REDONDO BEACH CA
90278-4716
US

V. Phone/Fax

Practice location:
  • Phone: 631-371-9443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number158837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: