Provider Demographics
NPI:1366593733
Name:FRONT, ADAM L (PHD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:L
Last Name:FRONT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4730
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-0730
Mailing Address - Country:US
Mailing Address - Phone:510-703-6677
Mailing Address - Fax:925-849-5880
Practice Address - Street 1:2821 CROW CANYON RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1659
Practice Address - Country:US
Practice Address - Phone:510-703-6677
Practice Address - Fax:925-849-5880
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15267103TA0400X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical