MEDICARE: MS. ANDREA L. FRYS 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
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00030241501	OTHER	NY	UNIVERA
2	000506354005	OTHER	NY	COMMUNITY BLUE

General Provider Information

NPI Number	:	1477664126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA L. FRYS LCSW

Provider Business Mailing Address
First Line	:	5120 ORCHARD AVE
Second Line	:
City	:	HAMBURG
State	:	NY
Zip	:	14075-5657
Country	:	US
Telephone Number	:	716-926-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 S PARK AVE
Second Line	:
City	:	BLASDELL
State	:	NY
Zip	:	14219-1805
Country	:	US
Telephone Number	:	716-926-1750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/08/2020

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