Provider Demographics
NPI:1033414875
Name:FRITZ, SANDRA V (LCADC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:V
Last Name:FRITZ
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 HWY 35
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5907
Mailing Address - Country:US
Mailing Address - Phone:732-747-0094
Mailing Address - Fax:732-747-1095
Practice Address - Street 1:211 HWY 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5907
Practice Address - Country:US
Practice Address - Phone:732-747-0094
Practice Address - Fax:732-747-1095
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00032100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)