Provider Demographics
NPI:1134437502
Name:FRONZAGLIA, TAMMY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:ANN
Last Name:FRONZAGLIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 KIRKBRIDE DRIVE
Mailing Address - Street 2:DANVILLE STATE HOSPITAL
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-9195
Mailing Address - Country:US
Mailing Address - Phone:570-271-4601
Mailing Address - Fax:570-271-4802
Practice Address - Street 1:50 KIRKBRIDE DRIVE
Practice Address - Street 2:DANVILLE STATE HOSPITAL
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-9195
Practice Address - Country:US
Practice Address - Phone:570-271-4601
Practice Address - Fax:570-271-4802
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016809103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103198509OtherMEDICAL ASSISTANCE