Provider Demographics
NPI:1083893077
Name:FRASER, CARA LYNN (LCSW-R, MPA)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:LYNN
Last Name:FRASER
Suffix:
Gender:F
Credentials:LCSW-R, MPA
Other - Prefix:MS
Other - First Name:CARA
Other - Middle Name:LYNN
Other - Last Name:GILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, MPA
Mailing Address - Street 1:257 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2522
Mailing Address - Country:US
Mailing Address - Phone:607-729-6206
Mailing Address - Fax:607-729-1858
Practice Address - Street 1:257 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2522
Practice Address - Country:US
Practice Address - Phone:607-729-6206
Practice Address - Fax:607-729-1858
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0733633-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400176546Medicare PIN