Provider Demographics
NPI:1316173719
Name:KROLL, ROBIN B (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:B
Last Name:KROLL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 N AVONDALE AVE #111
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:847-778-9322
Mailing Address - Fax:847-726-9320
Practice Address - Street 1:6323 N AVONDALE AVE
Practice Address - Street 2:#111
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:847-778-9322
Practice Address - Fax:847-726-9320
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007698103T00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No103T00000XBehavioral Health & Social Service ProvidersPsychologist