Provider Demographics
NPI:1447679576
Name:FRUGE' PSYCHOLOGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:FRUGE' PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRUGE'
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, QME
Authorized Official - Phone:510-759-4405
Mailing Address - Street 1:1300 CLAY ST STE 600
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1427
Mailing Address - Country:US
Mailing Address - Phone:510-759-4405
Mailing Address - Fax:
Practice Address - Street 1:1300 CLAY ST STE 600
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1427
Practice Address - Country:US
Practice Address - Phone:510-759-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty