Provider Demographics
NPI:1487189833
Name:FRY, KATHY (MHS-BSL)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:MHS-BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1446
Mailing Address - Country:US
Mailing Address - Phone:570-523-1297
Mailing Address - Fax:
Practice Address - Street 1:60 N 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1446
Practice Address - Country:US
Practice Address - Phone:570-523-1297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst