Provider Demographics
NPI:1154487163
Name:FRITTS, CYNTHIA J (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:FRITTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:J
Other - Last Name:RISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1707 N 12TH ST
Mailing Address - Street 2:BLDG 29M
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-222-9487
Mailing Address - Fax:217-222-8578
Practice Address - Street 1:1707 N 12TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-222-8641
Practice Address - Fax:217-222-8578
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
202175Medicare ID - Type Unspecified