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General NPI Number Information
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NPI Number | 1740587559
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Entity Type | Individual
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Provider Name | ANTHONY M. MCCROVITZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 621 BROADWAY
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City | CHESTERTON
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State | IN
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Zip | 46304-2259
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Country | US
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Telephone | 219-921-5492
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Fax | 219-921-0143
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Provider Business Mailing Address
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Address Line | 1880 CATKIN CIRCLE
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City | CHESTERTON
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State | IN
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Zip | 46304
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Country | US
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Telephone | 219-771-2940
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Fax | 219-921-0143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39002197A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20043441A
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License Number State | IN
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