Provider Demographics
NPI:1740030030
Name:FRIAS, JESSICA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:FRIAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11850 DR MARTIN LUTHER KING JR ST N APT 15310
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1634
Mailing Address - Country:US
Mailing Address - Phone:954-218-9338
Mailing Address - Fax:
Practice Address - Street 1:615 E PRINCETON ST STE 240
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1465
Practice Address - Country:US
Practice Address - Phone:407-303-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist