Provider Demographics
NPI:1750484671
Name:FRUMKIN, BETH BRAZIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:BRAZIN
Last Name:FRUMKIN
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 1:2011 BRIGHTWATERS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3009
Mailing Address - Country:US
Mailing Address - Phone:508-314-5477
Mailing Address - Fax:727-821-2758
Practice Address - Street 1:2011 BRIGHTWATERS BLVD NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3009
Practice Address - Country:US
Practice Address - Phone:508-314-5477
Practice Address - Fax:727-821-2758
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4717103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY 8655OtherSTATE OF FLORIDA PSYCHOLOGIST LICENSE NUMBER