1407806284 NPI number — MS. LISA LYNN FRADY L.C.S.W.

Table of content: MS. LISA LYNN FRADY L.C.S.W. (NPI 1407806284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407806284 NPI number — MS. LISA LYNN FRADY L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRADY
Provider First Name:
LISA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRICHTON
Provider Other First Name:
LISA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407806284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 LUCERNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT DORA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32757-3639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-446-2011
Provider Business Mailing Address Fax Number:
352-385-0128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 LUCERNE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT DORA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32757-3639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-446-2011
Provider Business Practice Location Address Fax Number:
352-385-0128
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW 10470 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2088872 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273250802 . This is a "MAGELLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273250802 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: TN01R5620547289R5 . This is a "JOHNDEERE-BEHAVIOR HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 273250802 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273250802 . This is a "PSYCHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3927870 . This is a "FEI-BEHAVIORAL HEALTH PRO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 022688 . This is a "VMC - BEHAVIORAL HEALTH P" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 11442656 . This is a "CAQH-BEHAVIOR HEALTH PROV" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 832983633 . This is a "UHC/UBH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: A7820954 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000509 . This is a "TENNCARE-BEH HEALTH PROV" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5389124 . This is a "AETNA-BEHAVIORAL HEALTH P" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 11442656 . This is a "CAQH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 166375 . This is a "MHNETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12885505 . This is a "MULTIPLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 264470000 . This is a "MAGELLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4208400 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 658507 . This is a "VALUE OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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