Basic Information
| Provider Information | |||||||||
| NPI: | 1992035976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRY | ||||||||
| FirstName: | MASHA | ||||||||
| MiddleName: | NAOMI | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15455 65TH AVE S | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TUKWILA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981882534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067215170 | ||||||||
| FaxNumber: | 2067216288 | ||||||||
| Practice Location | |||||||||
| Address1: | 15455 65TH AVE S | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TUKWILA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981882534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067215170 | ||||||||
| FaxNumber: | 2067216288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2010 | ||||||||
| LastUpdateDate: | 07/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | RC00053930 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.