Provider Demographics
NPI:1144701251
Name:FRITCHY, MARISA (LICSW)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:FRITCHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:NARDELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:40 BEACON ST E
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3437
Mailing Address - Country:US
Mailing Address - Phone:603-524-1100
Mailing Address - Fax:
Practice Address - Street 1:40 BEACON ST E
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3437
Practice Address - Country:US
Practice Address - Phone:603-524-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH29871041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health