Provider Demographics
NPI:1336150390
Name:FROHLICH, JONATHAN STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STEVEN
Last Name:FROHLICH
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 1:416 BEATRICE ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2548
Mailing Address - Country:US
Mailing Address - Phone:201-836-3280
Mailing Address - Fax:
Practice Address - Street 1:416 BEATRICE ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2548
Practice Address - Country:US
Practice Address - Phone:201-836-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00433900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical