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NPI Code Detail

MEDICARE: BRADI FRITTS LCSW

MEDICARE: BRADI FRITTS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLCSW-37109ID
21041C0700XClinical Social WorkerL5068OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043517105
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADI FRITTS LCSW
Provider Business Mailing Address
First Line : 1100 NW 12TH ST
Second Line :
City : FRUITLAND
State : ID
Zip : 83619-5040
Country : US
Telephone Number : 208-452-6556
Fax Number : 541-216-6557
Provider Business Practice Location Address
First Line : 1100 NW 12TH ST
Second Line :
City : FRUITLAND
State : ID
Zip : 83619-5040
Country : US
Telephone Number : 208-739-6248
Fax Number : 541-216-6557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2011
Last Update Date : 10/24/2023

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Directions to “ BRADI FRITTS LCSW” Practice Location

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