Elissa Fronczak, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301012322 Issued in MI

Practice address

235 Pine Ave Apt K
Carlsbad, CA 92008-3177

Phone

(734) 776-1127

NPI assigned

Apr 12, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Henry Ford Health Eastwood Behavioral Health

  • Social Worker
  • Clinton Township, MI
  • NPI 1396787701
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1649494576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2772 ROOSEVELT ST # 4489",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920081615",
            "telephone_number": "734-776-1127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 PINE AVE APT K",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920083177",
            "telephone_number": "734-776-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRONCZAK",
        "first_name": "ELISSA",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301012322",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6301012322",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Brian Fried, MA, LMFT
• Kimberly Sher Fried, L.AC.
• Gail Laurie Friedt, RN
• Benjamin Mark Frishberg, M.D.
• William Charles Fritter
• Front Porch Communities and Services
• Gregory P Frost, DC
• Victoria Frost
• Jeffrey W Fruin, DDS
• Susan Fuerst, FNP

• Clinical Psychologist in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.