Healthcare Provider Details

I. General information

NPI: 1457471609
Provider Name (Legal Business Name): DEETTE ANN FRARY M.S., ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 NEW COUNTRY DR APT 5
CICERO NY
13039-8641
US

IV. Provider business mailing address

8751 NEW COUNTRY DR APT 5
CICERO NY
13039-8359
US

V. Phone/Fax

Practice location:
  • Phone: 315-657-1505
  • Fax:
Mailing address:
  • Phone: 315-657-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000541-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: