Provider Demographics
NPI:1184835423
Name:ROGER K FRETZ P H D INC
Entity Type:Organization
Organization Name:ROGER K FRETZ P H D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:FRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:717-627-4624
Mailing Address - Street 1:57 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1941
Mailing Address - Country:US
Mailing Address - Phone:717-627-4624
Mailing Address - Fax:717-627-4624
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1941
Practice Address - Country:US
Practice Address - Phone:717-627-4624
Practice Address - Fax:717-627-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003768L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS003768LOtherLICENSE
PAPS003768LOtherLICENSE