Provider Demographics
NPI:1972566008
Name:FRYE, DEANNA (PHD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:FRYE
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 1:3869 DARROW RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2691
Mailing Address - Country:US
Mailing Address - Phone:330-688-0800
Mailing Address - Fax:330-688-0801
Practice Address - Street 1:3869 DARROW RD
Practice Address - Street 2:SUITE 104
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2691
Practice Address - Country:US
Practice Address - Phone:330-688-0800
Practice Address - Fax:330-688-0801
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2005163Medicaid
OH2005163Medicaid