Provider Demographics
NPI:1700348158
Name:FRIGA, KELLIE LYNN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:KELLIE
Middle Name:LYNN
Last Name:FRIGA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2302
Mailing Address - Country:US
Mailing Address - Phone:585-615-2597
Mailing Address - Fax:
Practice Address - Street 1:15 COSTAR ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1114
Practice Address - Country:US
Practice Address - Phone:585-277-0190
Practice Address - Fax:585-277-0108
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104678-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool