Gricelda Fragoso, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1131 Issued in OK

Practice address

1985 W 33Rd St
Suite 110
Edmond, OK 73013-3875

Phone

(405) 309-9051

NPI assigned

Mar 1, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Gricelda Fragoso PSYD a Professional Psychology Corporation

  dba Mind Body Soul Psychology

  • Clinical Psychologist
  • Encinitas, CA
  • NPI 1669012787
  Medicare reassignment NPD Authorized official
• Millennium Medical Services, L.L.C.

  • Psychiatry Physician
  • Norman, OK
  • NPI 1245286285

  Clinical

  NPD (past)

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1689702540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1985 W 33RD ST",
            "address_2": "SUITE 110",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133875",
            "telephone_number": "405-309-9051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 W 33RD ST",
            "address_2": "SUITE 110",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133875",
            "telephone_number": "405-309-9051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAGOSO",
        "first_name": "GRICELDA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "21847",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OK",
            "license": "1131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAN DIEGO HHSA (EPSDT)",
            "identifier": "10138",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Foundation Radiology Group PC
• Foundation Weightwise Services, LLC (WeightWise at Edmond)
• Steven Shawn Fowler, LPC
• Kimberly A Fox, MS, CCC-SLP
• Rachel Fox
• Fraley Clinic PLLC
• Andrea Fraley, MD
• Gary Bob Fraley, M.D.
• Vanessa Yamileth Franco
• Madison R Frank, MS

• Clinical Psychologist in Edmond, OK
• Providers in Edmond, OK by specialty
• Clinical Psychologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.