Individual
JEFFREY FREMONT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1264 WYOMING AVE, FORTY FORT, PA 18704-4138
(570) 288-8795
(570) 288-3165
Mailing address
1264 WYOMING AVE, FORTY FORT, PA 18704-4138
(570) 288-8795
(570) 288-3165
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS004172L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019683050002
—
PA
01
—
445983
HIGHMARK BLUE SHIELD
PA
01
—
PS004172L
LICENSE NUMBER
PA
Enumeration date
09/13/2006
Last updated
07/09/2007
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