Provider Demographics
NPI:1891701850
Name:FRY, JEFFREY SCOT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOT
Last Name:FRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3593 BROOKEFALL CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7033
Mailing Address - Country:US
Mailing Address - Phone:866-525-2128
Mailing Address - Fax:866-514-9557
Practice Address - Street 1:370 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5467
Practice Address - Country:US
Practice Address - Phone:866-525-2128
Practice Address - Fax:866-514-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical