MEDICARE: DR. HENRY W KRONNER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149-008343	IL
2	1041C0700X	Clinical Social Worker	SW15604	FL

General Provider Information

NPI Number	:	1194825844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY W KRONNER PH.D.

Provider Business Mailing Address
First Line	:	2881 E OAKLAND PARK BLVD STE 118
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	773-456-1957
Fax Number	:

Provider Business Practice Location Address
First Line	:	2881 E OAKLAND PARK BLVD STE 118
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	773-456-1957
Fax Number	:	630-855-5890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	09/09/2022

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