Provider Demographics
NPI:1265009278
Name:FRIES, CHARLENE MARIE (MSED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MARIE
Last Name:FRIES
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NE 3RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4218
Mailing Address - Country:US
Mailing Address - Phone:954-256-0357
Mailing Address - Fax:
Practice Address - Street 1:107 NE 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4218
Practice Address - Country:US
Practice Address - Phone:954-256-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst