Healthcare Provider Details

I. General information

NPI: 1750484671
Provider Name (Legal Business Name): BETH BRAZIN FRUMKIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 BRIGHTWATERS BLVD NE
ST PETERSBURG FL
33704-3009
US

IV. Provider business mailing address

2011 BRIGHTWATERS BLVD NE
ST PETERSBURG FL
33704-3009
US

V. Phone/Fax

Practice location:
  • Phone: 508-314-5477
  • Fax: 727-821-2758
Mailing address:
  • Phone: 508-314-5477
  • Fax: 727-821-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4717
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: