Provider Demographics
NPI:1366518250
Name:FRITZ-PARKER, MARY CHRISTINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CHRISTINE
Last Name:FRITZ-PARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CHRISTINE
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:601 E 3RD ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6318
Mailing Address - Country:US
Mailing Address - Phone:618-225-9956
Mailing Address - Fax:618-465-9796
Practice Address - Street 1:601 E 3RD ST STE 302
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6318
Practice Address - Country:US
Practice Address - Phone:618-225-9956
Practice Address - Fax:618-465-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0108341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06032194OtherPROVIDER#FORBCBSOF IL
IL028182OtherVMC BEHAVIORAL HEALTHCARE SERVICES
IL028182OtherVMC BEHAVIORAL HEALTHCARE SERVICES