Provider Demographics
NPI:1770678682
Name:FRENDO, DENNIS FRENDRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:FRENDRICK
Last Name:FRENDO
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 1:15501 METROPOLITAN PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1684
Mailing Address - Country:US
Mailing Address - Phone:586-226-2822
Mailing Address - Fax:586-226-2833
Practice Address - Street 1:15501 METROPOLITAN PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1684
Practice Address - Country:US
Practice Address - Phone:586-226-2822
Practice Address - Fax:586-226-2833
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007382103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680E027030OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0P60520Medicare UPIN
MI680E027030OtherBLUE CROSS BLUE SHIELD OF MICHIGAN