Provider Demographics
NPI:1760500094
Name:FRITSCH, JAMES EDWARD (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:FRITSCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:J.
Other - Middle Name:EDWARD
Other - Last Name:FRITSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:15 ISLAND TRL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1603
Mailing Address - Country:US
Mailing Address - Phone:973-729-0644
Mailing Address - Fax:973-729-9757
Practice Address - Street 1:15 ISLAND TRL
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1603
Practice Address - Country:US
Practice Address - Phone:973-729-0644
Practice Address - Fax:973-729-9757
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001750001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFR640811Medicare ID - Type Unspecified