Provider Demographics
NPI:1578877189
Name:FRITZSCH, ELYSE JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:JOY
Last Name:FRITZSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:JOY
Other - Last Name:DE JONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:25 WALRAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2446
Mailing Address - Country:US
Mailing Address - Phone:978-621-4806
Mailing Address - Fax:
Practice Address - Street 1:85 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2437
Practice Address - Country:US
Practice Address - Phone:973-264-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9962631041C0700X
NJ44SC055462001041C0700X
104100000X
MA1172971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker