Provider Demographics
NPI:1023382017
Name:FRIED, KERRI ANNE
Entity type:Individual
Prefix:MS
First Name:KERRI
Middle Name:ANNE
Last Name:FRIED
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KERRI
Other - Middle Name:ANNE
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1810 E SAHARA AVE
Mailing Address - Street 2:SUITE 228
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3735
Mailing Address - Country:US
Mailing Address - Phone:702-373-2999
Mailing Address - Fax:
Practice Address - Street 1:1810 E SAHARA AVE
Practice Address - Street 2:SUITE 228
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3735
Practice Address - Country:US
Practice Address - Phone:702-373-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst