Provider Demographics
NPI:1831232461
Name:FRITZ, JAN M (MSW)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:M
Last Name:FRITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:MARY
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:509 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5218
Mailing Address - Country:US
Mailing Address - Phone:240-472-5888
Mailing Address - Fax:
Practice Address - Street 1:509 MARGARET DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5218
Practice Address - Country:US
Practice Address - Phone:240-472-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD083941041C0700X
DCLC3026821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD820870Medicare ID - Type UnspecifiedLCSW-C