Healthcare Provider Details

I. General information

NPI: 1417458274
Provider Name (Legal Business Name): DOUGLAS A FREW PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W MADISON ST STE 11
BALTIMORE MD
21201-2313
US

IV. Provider business mailing address

10 W MADISON ST STE 11
BALTIMORE MD
21201-2313
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: