Provider Demographics
NPI:1407094337
Name:FRASER, BERNICE OLIVE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:OLIVE
Last Name:FRASER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:BERNICE
Other - Middle Name:OLIVE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4810 AVE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:347-713-2814
Mailing Address - Fax:718-245-4468
Practice Address - Street 1:4810 AVE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:347-713-2814
Practice Address - Fax:718-258-4468
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038373104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N8C522Medicare UPIN