Provider Demographics
NPI:1952634388
Name:GREEN-FRITZ, CONSTANCE J (LCSW)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:J
Last Name:GREEN-FRITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ORCHARD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9237
Mailing Address - Country:US
Mailing Address - Phone:610-310-9109
Mailing Address - Fax:484-762-5288
Practice Address - Street 1:114 ORCHARD VIEW DR
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-9237
Practice Address - Country:US
Practice Address - Phone:610-310-9109
Practice Address - Fax:484-762-5288
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0177661041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1200051OtherCAQH
PA1952634388OtherNPI