1558869933 NPI number — EDYTA R FREY LCPC

Table of content: BRYAN LILLEY DPT (NPI 1346614468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558869933 NPI number — EDYTA R FREY LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREY
Provider First Name:
EDYTA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRZANOWSKA
Provider Other First Name:
EDYTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558869933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
157 BOURBON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-8007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-902-5628
Provider Business Mailing Address Fax Number:
443-495-6881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 WYNDHURST AVE STE 100F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21210-2489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-902-5628
Provider Business Practice Location Address Fax Number:
443-495-6881
Provider Enumeration Date:
01/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LC10003 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LC10003 . This is a "BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com