Provider Demographics
NPI:1144575804
Name:KRONFLI, TAREK (PSYD)
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:KRONFLI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 BROADWAY
Mailing Address - Street 2:SUITE
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2041
Mailing Address - Country:US
Mailing Address - Phone:510-628-9065
Mailing Address - Fax:
Practice Address - Street 1:1662 VILLAGE GRN STE 100
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2014
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0068103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist