Provider Demographics
NPI:1386126886
Name:FRIESWYK, ALLYSE M (LICSW)
Entity type:Individual
Prefix:
First Name:ALLYSE
Middle Name:M
Last Name:FRIESWYK
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 1:28 GOODHUE ST UNIT 405
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2282
Mailing Address - Country:US
Mailing Address - Phone:508-560-2585
Mailing Address - Fax:
Practice Address - Street 1:28 GOODHUE ST UNIT 405
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2282
Practice Address - Country:US
Practice Address - Phone:508-560-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1031568-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1031568-SW-LISCWMedicaid