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General NPI Number Information
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NPI Number | 1306116074
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Entity Type | Organization
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Legal Business Name | BRETT FRY, PSY.D., P.C.
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 405 N WABASH AVE SUITE 1815
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City | CHICAGO
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State | IL
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Zip | 60611-5661
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Country | US
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Telephone | 773-573-3612
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Fax |
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Provider Business Mailing Address
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Address Line | 405 N WABASH AVE SUITE 1815
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City | CHICAGO
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State | IL
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Zip | 60611-5661
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Country | US
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Telephone | 773-573-3612
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRETT FRY
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Credential | PSY.D.
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Telephone | 773-573-3612
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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 | 071006942
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License Number State | IL
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