Provider Demographics
NPI:1578665766
Name:FRY, JAY ASBURY (LISW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:ASBURY
Last Name:FRY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 GLENSIDE LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9485
Mailing Address - Country:US
Mailing Address - Phone:740-549-0145
Mailing Address - Fax:
Practice Address - Street 1:950 MEADOW DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1055
Practice Address - Country:US
Practice Address - Phone:419-947-4560
Practice Address - Fax:419-947-2956
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0007081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker