Provider Demographics
NPI:1972767499
Name:KRAFT, CHRISTINA A (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:A
Last Name:KRAFT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 ROCKSIDE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6802
Mailing Address - Country:US
Mailing Address - Phone:216-503-9489
Mailing Address - Fax:860-783-5590
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-379-8190
Practice Address - Fax:330-379-8191
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP6454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2887498Medicaid
OH2887498Medicaid