Provider Demographics
NPI:1417303157
Name:FRITZ, EDGAR TYRONE (LCSW)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:TYRONE
Last Name:FRITZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-8445
Mailing Address - Country:US
Mailing Address - Phone:865-681-4861
Mailing Address - Fax:877-852-8324
Practice Address - Street 1:2628 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-8445
Practice Address - Country:US
Practice Address - Phone:865-681-4861
Practice Address - Fax:877-852-8324
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW6365104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022498Medicaid