Provider Demographics
NPI:1992035976
Name:FRY, MASHA NAOMI (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MASHA
Middle Name:NAOMI
Last Name:FRY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15455 65TH AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2534
Mailing Address - Country:US
Mailing Address - Phone:206-721-5170
Mailing Address - Fax:206-721-6288
Practice Address - Street 1:15455 65TH AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2534
Practice Address - Country:US
Practice Address - Phone:206-721-5170
Practice Address - Fax:206-721-6288
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC000539301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical