Provider Demographics
NPI:1306116074
Name:BRETT FRY, PSY.D., P.C.
Entity type:Organization
Organization Name:BRETT FRY, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-573-3612
Mailing Address - Street 1:405 N WABASH AVE
Mailing Address - Street 2:SUITE 1815
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5661
Mailing Address - Country:US
Mailing Address - Phone:773-573-3612
Mailing Address - Fax:
Practice Address - Street 1:405 N WABASH AVE
Practice Address - Street 2:SUITE 1815
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5661
Practice Address - Country:US
Practice Address - Phone:773-573-3612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006942103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty