1912400607 NPI number — LUZELLY FRIAS LICSW

Table of content: LUZELLY FRIAS LICSW (NPI 1912400607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912400607 NPI number — LUZELLY FRIAS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIAS
Provider First Name:
LUZELLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912400607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 CANAL ST STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-995-6525
Provider Business Mailing Address Fax Number:
857-270-7171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 CANAL ST
Provider Second Line Business Practice Location Address:
FL 4
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-995-6525
Provider Business Practice Location Address Fax Number:
857-270-7171
Provider Enumeration Date:
03/09/2018

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:  121841 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: C015073 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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