Provider Demographics
NPI:1083703334
Name:FRY, DANA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:FRY
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:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-0384
Mailing Address - Country:US
Mailing Address - Phone:610-724-7117
Mailing Address - Fax:
Practice Address - Street 1:5 S CHESTER RD
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1718
Practice Address - Country:US
Practice Address - Phone:610-724-7117
Practice Address - Fax:267-343-8860
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-007966-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical