Provider Demographics
NPI:1912314931
Name:FRY, GRETCHEN ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:ANN
Last Name:FRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 WATERVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2257
Mailing Address - Country:US
Mailing Address - Phone:973-224-0704
Mailing Address - Fax:
Practice Address - Street 1:8018 WATERVIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2257
Practice Address - Country:US
Practice Address - Phone:973-224-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055751001041C0700X
FL167821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical