Provider Demographics
NPI:1689166852
Name:FRYE, ALICE ANDREA
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ANDREA
Last Name:FRYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WILDER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3057
Mailing Address - Country:US
Mailing Address - Phone:978-934-4208
Mailing Address - Fax:
Practice Address - Street 1:113 WILDER ST STE 300
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3057
Practice Address - Country:US
Practice Address - Phone:978-934-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical