Provider Demographics
NPI:1912400607
Name:FRIAS, LUZELLY (LICSW)
Entity Type:Individual
Prefix:
First Name:LUZELLY
Middle Name:
Last Name:FRIAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CANAL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2022
Mailing Address - Country:US
Mailing Address - Phone:857-995-6525
Mailing Address - Fax:857-270-7171
Practice Address - Street 1:90 CANAL ST
Practice Address - Street 2:FL 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2022
Practice Address - Country:US
Practice Address - Phone:857-995-6525
Practice Address - Fax:857-270-7171
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1218411041C0700X
NCC0150731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical