Healthcare Provider Details

I. General information

NPI: 1124141965
Provider Name (Legal Business Name): AMANDA FRYE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE
FULLERTON CA
92831-3839
US

IV. Provider business mailing address

4024 CENTRAL AVE 200
SAINT PETERSBURG FL
33711-1239
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-9073
  • Fax:
Mailing address:
  • Phone: 727-327-7656
  • Fax: 727-322-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: