Provider Demographics
NPI:1932682184
Name:FROSE, ADAM FISHEL (PHD, CCSH)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:FISHEL
Last Name:FROSE
Suffix:
Gender:M
Credentials:PHD, CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 S ABALONE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5642
Mailing Address - Country:US
Mailing Address - Phone:602-730-1385
Mailing Address - Fax:
Practice Address - Street 1:2266 S DOBSON RD STE 200
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6412
Practice Address - Country:US
Practice Address - Phone:602-730-1385
Practice Address - Fax:480-775-5123
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical