Provider Demographics
NPI:1407922990
Name:FROHWIRTH, RICHARD A (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:FROHWIRTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 STRAWBERRY HILL AVENUE
Mailing Address - Street 2:STE 304
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-324-1959
Mailing Address - Fax:203-324-1825
Practice Address - Street 1:125 STRAWBERRY HILL AVENUE
Practice Address - Street 2:STE 304
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-324-1959
Practice Address - Fax:203-324-1825
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTZS755OtherOXFORD
CT0004208110OtherAETNA PIN
CT06000561CT01OtherANTHEM BCBS
CT133473OtherVALUE OPTIONS
CT080339OtherMHN
CTV50901OtherEMPIRE HEALTH PLANS