Provider Demographics
NPI:1457871543
Name:FRETWELL, BRYNNE KAZLO (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYNNE
Middle Name:KAZLO
Last Name:FRETWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRYNNE
Other - Middle Name:WALKER
Other - Last Name:KAZLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1241 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-4632
Mailing Address - Country:US
Mailing Address - Phone:540-434-1941
Mailing Address - Fax:540-434-0132
Practice Address - Street 1:463 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802
Practice Address - Country:US
Practice Address - Phone:540-433-3100
Practice Address - Fax:540-434-0132
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040099721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical