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General NPI Number Information
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NPI Number | 1275579948
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Entity Type | Individual
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Provider Name | JEFFREY D. FROSS PHD, HSPP
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Gender | Male
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 4715 VIEWRIDGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92123-1680
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Country | US
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Telephone | 800-257-8715
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Fax | 800-819-1655
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Provider Business Mailing Address
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Address Line | 5302 E 70TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3840
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Country | US
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Telephone | 317-254-8476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20040572A
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License Number State | IN
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