MEDICARE: DR. CHARLES L. KRONBERG 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	103TC0700X	Clinical Psychologist	0591	NC

General Provider Information

NPI Number	:	1912027459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES L. KRONBERG PH.D.

Provider Business Mailing Address
First Line	:	725 GROVE AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-1611
Country	:	US
Telephone Number	:	919-851-3948
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 E FRANKLIN ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-2888
Country	:	US
Telephone Number	:	919-942-8596
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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