Provider Demographics
NPI:1235776907
Name:ANN WALLACE FRICK
Entity Type:Organization
Organization Name:ANN WALLACE FRICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-220-4125
Mailing Address - Street 1:603 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1422
Mailing Address - Country:US
Mailing Address - Phone:973-220-4125
Mailing Address - Fax:
Practice Address - Street 1:603 WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1422
Practice Address - Country:US
Practice Address - Phone:973-220-4125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty