Provider Demographics
NPI:1063112043
Name:FRUGIA, TODD DERRICK
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:DERRICK
Last Name:FRUGIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E WASHINGTON ST STE 1237
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1853
Mailing Address - Country:US
Mailing Address - Phone:773-450-9015
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1237
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1853
Practice Address - Country:US
Practice Address - Phone:773-450-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180015065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional