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General NPI Number Information
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NPI Number | 1417458274
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Entity Type | Individual
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Provider Name | DOUGLAS A FREW PSYD
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Gender | Male
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 02/26/2018
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Provider Practice Location Address
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Address Line | 10 W MADISON ST STE 11
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City | BALTIMORE
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State | MD
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Zip | 21201-2313
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Country | US
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Telephone | 443-438-7863
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Fax |
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Provider Business Mailing Address
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Address Line | 10 W MADISON ST STE 11
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City | BALTIMORE
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State | MD
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Zip | 21201-2313
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Country | US
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Telephone |
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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 | 05970
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License Number State | MD
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