Provider Demographics
NPI:1649542754
Name:FRICKA, KRISTIN E
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:FRICKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3069
Mailing Address - Country:US
Mailing Address - Phone:508-849-5600
Mailing Address - Fax:
Practice Address - Street 1:129 BLACKSTONE RIVER RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1491
Practice Address - Country:US
Practice Address - Phone:508-757-5579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health