Healthcare Provider Details

I. General information

NPI: 1497136394
Provider Name (Legal Business Name): ROBERT FREY PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 WHEELER ST
CINCINNATI OH
45219-1219
US

IV. Provider business mailing address

1101 SUMMIT RD
CINCINNATI OH
45237-2621
US

V. Phone/Fax

Practice location:
  • Phone: 513-313-3737
  • Fax: 513-241-4307
Mailing address:
  • Phone: 513-948-3721
  • Fax: 513-948-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA 115616-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN 267061-1
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCTP 15616-EX1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: