Basic Information
Provider Information | |||||||||
NPI: | 1992992663 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FRITZ | ||||||||
FirstName: | NICOLE | ||||||||
MiddleName: | RENEE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW LISW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ALBAIN | ||||||||
OtherFirstName: | NICOLE | ||||||||
OtherMiddleName: | RENEE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6605 WEST CENTRAL AVENUE | ||||||||
Address2: |   | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 436171000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4198417701 | ||||||||
FaxNumber: | 4198411691 | ||||||||
Practice Location | |||||||||
Address1: | 6601 WEST CENTRAL AVENUE | ||||||||
Address2: |   | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 436171000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4198417701 | ||||||||
FaxNumber: | 4198411691 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2007 | ||||||||
LastUpdateDate: | 06/18/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.1440312 | OH | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.