Provider Demographics
NPI:1992155998
Name:DONNA FRYDMAN
Entity type:Organization
Organization Name:DONNA FRYDMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-350-5522
Mailing Address - Street 1:350 CAMINO GARDENS BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5846
Mailing Address - Country:US
Mailing Address - Phone:561-350-5522
Mailing Address - Fax:
Practice Address - Street 1:350 CAMINO GARDENS BLVD
Practice Address - Street 2:STE 105
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5846
Practice Address - Country:US
Practice Address - Phone:561-350-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC7330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty