Provider Demographics
NPI:1700265477
Name:FRITZ, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FRITZ
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 1:25 S BROAD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2255
Mailing Address - Country:US
Mailing Address - Phone:610-365-8989
Mailing Address - Fax:610-365-8994
Practice Address - Street 1:25 S BROAD ST
Practice Address - Street 2:STE 101
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2255
Practice Address - Country:US
Practice Address - Phone:610-365-8989
Practice Address - Fax:610-365-8994
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health