Provider Demographics
NPI:1881613362
Name:FRYDENBORG, CHRISTINE ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:FRYDENBORG
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 1:75 GILCREAST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3564
Mailing Address - Country:US
Mailing Address - Phone:603-437-3393
Mailing Address - Fax:603-437-3393
Practice Address - Street 1:75 GILCREAST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3564
Practice Address - Country:US
Practice Address - Phone:603-437-3393
Practice Address - Fax:603-437-3393
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH929103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422790Medicaid
NH30422790Medicaid