Provider Demographics
NPI:1194290247
Name:FRY, ANN (LICSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7248
Mailing Address - Country:US
Mailing Address - Phone:617-335-0229
Mailing Address - Fax:
Practice Address - Street 1:THE GIFFORD SCHOOL
Practice Address - Street 2:177 BOSTON POST ROAD
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493
Practice Address - Country:US
Practice Address - Phone:781-899-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10247331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical