Provider Demographics
NPI:1417478116
Name:FRYAR, LAURA M (LMHC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:FRYAR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NAVARRE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4725
Mailing Address - Country:US
Mailing Address - Phone:617-893-1253
Mailing Address - Fax:
Practice Address - Street 1:30 EASTBROOK RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2048
Practice Address - Country:US
Practice Address - Phone:781-686-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health