Provider Demographics
NPI:1346214863
Name:FRAIJO, FREDERICK MARK (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:MARK
Last Name:FRAIJO
Suffix:
Gender:M
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5771
Mailing Address - Country:US
Mailing Address - Phone:719-630-0447
Mailing Address - Fax:
Practice Address - Street 1:7500 COCHRANE CIR.
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-8410
Practice Address - Fax:719-526-0608
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9920941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical