Provider Demographics
NPI:1760640783
Name:GERTNER FRITTS, CAREN RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAREN
Middle Name:RAE
Last Name:GERTNER FRITTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 SPELLMAN RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-6022
Mailing Address - Country:US
Mailing Address - Phone:713-253-2492
Mailing Address - Fax:936-653-3787
Practice Address - Street 1:4502 SPELLMAN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6022
Practice Address - Country:US
Practice Address - Phone:713-253-2492
Practice Address - Fax:936-653-3787
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033338703Medicaid
TX8L6958Medicare PIN
TX03338702Medicaid