Individual
ANTOINETTE CROCILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD LP
Contact information
Practice address
127 N WASHINGTON ST, YPSILANTI, MI 48197-2619
(734) 682-5544
Mailing address
127 N WASHINGTON ST, YPSILANTI, MI 48197-2619
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301016439
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982147302
—
MI
Enumeration date
09/15/2013
Last updated
09/01/2021
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