MEDICARE: DR. FRANK D. DEFOREST PH.D.

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	103T00000X	Psychologist	0810001612	VA

General Provider Information

NPI Number	:	1952360109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK D. DEFOREST PH.D.

Provider Business Mailing Address
First Line	:	600 JACKSON ST
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5719
Country	:	US
Telephone Number	:	540-899-4380
Fax Number	:	540-371-3753

Provider Business Practice Location Address
First Line	:	600 JACKSON ST
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5719
Country	:	US
Telephone Number	:	540-899-4380
Fax Number	:	540-371-3753

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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