Provider Demographics
NPI:1356500920
Name:FRASER, SAMUEL ERIC (PHD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ERIC
Last Name:FRASER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7136 HASKELL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4112
Mailing Address - Country:US
Mailing Address - Phone:626-644-4746
Mailing Address - Fax:818-888-7850
Practice Address - Street 1:7136 HASKELL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:626-644-4746
Practice Address - Fax:818-888-7850
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23931101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)