Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1043662372 |
---|---|
Provider Name | William Frye |
First Address | St Petersburg, FL 33701-4825 |
Second Address | St Petersburg, FL 33701-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 21/08/2019 |