Provider Demographics
NPI:1407166457
Name:FRYREAR, SANDRA A (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:A
Last Name:FRYREAR
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BROOKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-7432
Mailing Address - Country:US
Mailing Address - Phone:914-923-5700
Mailing Address - Fax:914-923-5790
Practice Address - Street 1:315 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-2031
Practice Address - Country:US
Practice Address - Phone:914-923-5700
Practice Address - Fax:914-923-5790
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0728581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical