Healthcare Provider Details

I. General information

NPI: 1346759727
Provider Name (Legal Business Name): LORI ANN KROENER PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 INDEPENDENCE BLVD STE 204
VIRGINIA BEACH VA
23455-5542
US

IV. Provider business mailing address

1020 INDEPENDENCE BLVD STE 204
VIRGINIA BEACH VA
23455-5542
US

V. Phone/Fax

Practice location:
  • Phone: 757-640-1882
  • Fax:
Mailing address:
  • Phone: 757-640-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810002838
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: