Provider Demographics
NPI:1568469187
Name:FRY, CYNTHIA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JO
Last Name:FRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 BRICK CHURCH PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2002
Mailing Address - Country:US
Mailing Address - Phone:615-227-8070
Mailing Address - Fax:615-226-9475
Practice Address - Street 1:3550 BRICK CHURCH PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2002
Practice Address - Country:US
Practice Address - Phone:615-227-8070
Practice Address - Fax:615-226-9475
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000000181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3647063Medicare ID - Type Unspecified