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NPI Code Detail

MEDICARE: KAREN LEA FRY LCSW

MEDICARE: KAREN LEA FRY 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
11041C0700XClinical Social Worker2348-CAR

General Provider Information

NPI Number : 1336217355
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN LEA FRY LCSW
Provider Business Mailing Address
First Line : 20 SILVERLEAF CT
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72210-4731
Country : US
Telephone Number : 501-425-2814
Fax Number : 501-441-6861
Provider Business Practice Location Address
First Line : 2301 SPRINGHILL RD STE 200
Second Line :
City : BENTON
State : AR
Zip : 72019-7566
Country : US
Telephone Number : 501-425-2814
Fax Number : 501-441-6861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 03/05/2024

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