Provider Demographics
NPI:1316018393
Name:FRASER, BRENDA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LULL ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1419
Mailing Address - Country:US
Mailing Address - Phone:781-329-3553
Mailing Address - Fax:
Practice Address - Street 1:371B WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-413-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1116161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23397Medicare ID - Type UnspecifiedPRIV.PRACTICE MEDICAREB
MAP23183Medicare ID - Type UnspecifiedWAYSIDE MEDICARE B