Provider Demographics
NPI:1013948926
Name:FRIED, GERALD LEONARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LEONARD
Last Name:FRIED
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 1:808 WEST HILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909
Mailing Address - Country:US
Mailing Address - Phone:865-588-7598
Mailing Address - Fax:865-588-6406
Practice Address - Street 1:6231 HIGHLAND PLACE WAY STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4083
Practice Address - Country:US
Practice Address - Phone:865-264-2400
Practice Address - Fax:865-588-6406
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW6731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3693681Medicaid
TN3693681Medicare ID - Type UnspecifiedMEDICARE