Provider Demographics
NPI:1164811410
Name:FRAZIER, MICHAELA (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 7TH ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1902
Mailing Address - Country:US
Mailing Address - Phone:845-893-6362
Mailing Address - Fax:
Practice Address - Street 1:284 7TH ST
Practice Address - Street 2:BASEMENT
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1902
Practice Address - Country:US
Practice Address - Phone:845-893-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 088606104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker