Provider Demographics
NPI:1346996873
Name:FRASER, ANGELLA PATRICIA
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:PATRICIA
Last Name:FRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 SUNSET STRIP
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6106
Mailing Address - Country:US
Mailing Address - Phone:954-333-8787
Mailing Address - Fax:954-333-8621
Practice Address - Street 1:1060 SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-6106
Practice Address - Country:US
Practice Address - Phone:954-333-8787
Practice Address - Fax:954-333-8621
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health