Provider Demographics
NPI:1750974135
Name:FRYAR, ARTRESIA
Entity type:Individual
Prefix:
First Name:ARTRESIA
Middle Name:
Last Name:FRYAR
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 1:16 ARI DR APT A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4544
Mailing Address - Country:US
Mailing Address - Phone:908-451-7299
Mailing Address - Fax:
Practice Address - Street 1:16 ARI DR APT A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4544
Practice Address - Country:US
Practice Address - Phone:908-451-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06270300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker