Provider Demographics
NPI:1619745411
Name:FREY, ANNIE L
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:L
Last Name:FREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SOMERSET LN APT 402
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2422
Mailing Address - Country:US
Mailing Address - Phone:917-250-9652
Mailing Address - Fax:
Practice Address - Street 1:90 BROAD ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-3313
Practice Address - Country:US
Practice Address - Phone:646-504-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06999500104100000X
NY119291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker