Basic Information
| Provider Information | |||||||||
| NPI: | 1063185304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KROKONKO | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1002 | ||||||||
| Address2: | |||||||||
| City: | MILLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175510302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177362526 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3740 CHAMBERS HILL RD | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171111510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172385553 | ||||||||
| FaxNumber: | 7172327362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2021 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 227036 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.