Provider Demographics
NPI:1154313294
Name:FRY, DEBORAH (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 N SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4015
Mailing Address - Country:US
Mailing Address - Phone:773-251-1363
Mailing Address - Fax:773-866-2566
Practice Address - Street 1:1300 W BELMONT AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:773-251-1363
Practice Address - Fax:773-866-2566
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional