Provider Demographics
NPI:1922693217
Name:LUNA FRITH, LLC
Entity Type:Organization
Organization Name:LUNA FRITH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LUNA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:FRITH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-923-8226
Mailing Address - Street 1:38 COTTAGE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1610
Mailing Address - Country:US
Mailing Address - Phone:413-923-8226
Mailing Address - Fax:
Practice Address - Street 1:2 ALLEN ST
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:MA
Practice Address - Zip Code:01036-9552
Practice Address - Country:US
Practice Address - Phone:413-282-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1518476449OtherNPI