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General NPI Number Information
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NPI Number | 1205934585
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Entity Type | Organization
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Legal Business Name | THOMAS D KRAFT PHD INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 280 N PARK AVENUE SUITE 207
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City | WARREN
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State | OH
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Zip | 44481-1109
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Country | US
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Telephone | 330-392-9216
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 MILLIKIN PLACE NE
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City | WARREN
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State | OH
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Zip | 44483-4447
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Country | US
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Telephone | 330-372-5883
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL DIRECTOR
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Name | DR. THOMAS DILLON KRAFT
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Credential | PHD
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Telephone | 330-372-5883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2511
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License Number State | OH
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