Basic Information
Provider Information
NPI: 1003293242
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KROLL
FirstName: ALICE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 420 QUAKER FARMS RD
Address2:  
City: OXFORD
State: CT
PostalCode: 064781307
CountryCode: US
TelephoneNumber: 2033051012
FaxNumber: 2038885275
Practice Location
Address1: 420 QUAKER FARMS RD
Address2:  
City: OXFORD
State: CT
PostalCode: 064781307
CountryCode: US
TelephoneNumber: 2033051012
FaxNumber: 2038885275
Other Information
ProviderEnumerationDate: 04/27/2015
LastUpdateDate: 04/27/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X002639CTY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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