Basic Information
| Provider Information | |||||||||
| NPI: | 1013948926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIED | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | LEONARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 WEST HILLS ROAD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655887598 | ||||||||
| FaxNumber: | 8655886406 | ||||||||
| Practice Location | |||||||||
| Address1: | 6231 HIGHLAND PLACE WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379194083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652642400 | ||||||||
| FaxNumber: | 8655886406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW673 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 3693681 | 05 | TN | MEDICAID |