Provider Demographics
NPI:1043875552
Name:FRYAZIN, NATALYA V
Entity type:Individual
Prefix:MRS
First Name:NATALYA
Middle Name:V
Last Name:FRYAZIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:V
Other - Last Name:BELOSHEVSKAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4401 PARK AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6360
Mailing Address - Country:US
Mailing Address - Phone:646-404-3452
Mailing Address - Fax:
Practice Address - Street 1:444 60TH ST.
Practice Address - Street 2:2ND FLR
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-430-5233
Practice Address - Fax:201-210-4435
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00469200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor