Provider Demographics
NPI:1689156440
Name:FRITCHLEY, JOSEPH R (LLMSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:FRITCHLEY
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1833
Mailing Address - Country:US
Mailing Address - Phone:517-323-4734
Mailing Address - Fax:517-886-1168
Practice Address - Street 1:2800 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1833
Practice Address - Country:US
Practice Address - Phone:517-323-4734
Practice Address - Fax:517-886-1168
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011015531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical