Provider Demographics
NPI:1336486125
Name:FRAZER, BRUCE (LMHC,LADC I)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:FRAZER
Suffix:
Gender:M
Credentials:LMHC,LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3752
Mailing Address - Country:US
Mailing Address - Phone:508-979-5617
Mailing Address - Fax:
Practice Address - Street 1:70 LINDSEY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3752
Practice Address - Country:US
Practice Address - Phone:508-979-5617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA396101YA0400X
MA895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)