Provider Demographics
NPI:1063969202
Name:KRONHOLM, AGNIESZKA KAROLINA SERWIK (PHD)
Entity type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:KAROLINA SERWIK
Last Name:KRONHOLM
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 UNION ST
Practice Address - Street 2:9
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3050
Practice Address - Country:US
Practice Address - Phone:207-973-4037
Practice Address - Fax:207-973-8276
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPS1353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPS1353OtherPSYCHOLOGIST