Provider Demographics
NPI:1225105778
Name:FRALEY, ELISA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:
Last Name:FRALEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 METRO PKWY
Mailing Address - Street 2:STE 205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:561-747-2775
Mailing Address - Fax:561-747-1881
Practice Address - Street 1:4425 MILITARY TRAIL
Practice Address - Street 2:SUITE203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4817
Practice Address - Country:US
Practice Address - Phone:561-383-8000
Practice Address - Fax:561-514-1275
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW49011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW4901OtherSTATE LICENSE