MEDICARE: MS. DEBORAH FRY L.C.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1154313294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH FRY L.C.P.C.

Provider Business Mailing Address
First Line	:	3845 N SPRINGFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4015
Country	:	US
Telephone Number	:	773-251-1363
Fax Number	:	773-866-2566

Provider Business Practice Location Address
First Line	:	1300 W BELMONT AVE
Second Line	:	SUITE 216
City	:	CHICAGO
State	:	IL
Zip	:	60657-3200
Country	:	US
Telephone Number	:	773-251-1363
Fax Number	:	773-866-2566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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