Provider Demographics
NPI:1063185304
Name:KROKONKO, OLIVIA T (BSW)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:T
Last Name:KROKONKO
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-0302
Mailing Address - Country:US
Mailing Address - Phone:717-736-2526
Mailing Address - Fax:
Practice Address - Street 1:3740 CHAMBERS HILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1510
Practice Address - Country:US
Practice Address - Phone:717-238-5553
Practice Address - Fax:717-232-7362
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA227036261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder