Provider Demographics
NPI:1891486635
Name:FROST, TEMUJIN
Entity Type:Individual
Prefix:
First Name:TEMUJIN
Middle Name:
Last Name:FROST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4106
Mailing Address - Country:US
Mailing Address - Phone:888-922-2843
Mailing Address - Fax:
Practice Address - Street 1:278 MILL RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4106
Practice Address - Country:US
Practice Address - Phone:888-922-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician