Healthcare Provider Details

I. General information

NPI: 1740587559
Provider Name (Legal Business Name): ANTHONY M. MCCROVITZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BROADWAY
CHESTERTON IN
46304-2259
US

IV. Provider business mailing address

1880 CATKIN CIRCLE
CHESTERTON IN
46304
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-5492
  • Fax: 219-921-0143
Mailing address:
  • Phone: 219-771-2940
  • Fax: 219-921-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002197A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20043441A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: