Provider Demographics
NPI:1740319425
Name:FRETZ, ROGER KEITH (PHD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KEITH
Last Name:FRETZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1941
Mailing Address - Country:US
Mailing Address - Phone:717-627-4624
Mailing Address - Fax:717-627-4455
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1941
Practice Address - Country:US
Practice Address - Phone:717-627-4624
Practice Address - Fax:717-627-4455
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003768L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical