Kathleen M. Fry, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810007470 Issued in VA

Practice address

602 Cardinal LN
Tyngsboro, MA 01879-1583

Phone

(978) 815-4800

NPI assigned

Jun 6, 2011

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.

• Center for Trauma, Recovery, and Wellness

  • Clinical Psychologist
  • Sandy, UT
  • NPI 1639895790
  NPD Authorized official

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

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1790079994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 E 11190 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840945329",
            "telephone_number": "978-815-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 CARDINAL LN",
            "city": "TYNGSBORO",
            "state": "MA",
            "postal_code": "018791583",
            "telephone_number": "978-815-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRY",
        "first_name": "KATHLEEN",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-06",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810007470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Francis Frazier Jr.
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• Lauren Friedman, LICSW
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• David R Frost, D.C.
• Full Spectrum Physical Therapy and Performance, LLC
• Emily Gillotte, LMHC
• Gokul Adult Day Care, Inc
• Greater Lowell Technical High School
• Virginia Marie Greco, R.D., L.D.N.

• Clinical Psychologist in Tyngsboro, MA
• Providers in Tyngsboro, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.