Provider Demographics
NPI:1033504188
Name:FRYE, MOLLY (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 SE FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1738
Mailing Address - Country:US
Mailing Address - Phone:503-780-3010
Mailing Address - Fax:
Practice Address - Street 1:3939 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:503-780-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical