Provider Demographics
NPI:1437358512
Name:FRAGIOUDAKIS, MARIA M (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:M
Last Name:FRAGIOUDAKIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:M
Other - Last Name:FRAGIOUDAKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4910 AIRPORT AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5759
Mailing Address - Country:US
Mailing Address - Phone:281-239-1381
Mailing Address - Fax:281-239-0828
Practice Address - Street 1:4910 AIRPORT AVE
Practice Address - Street 2:BLDG D
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5759
Practice Address - Country:US
Practice Address - Phone:281-239-1381
Practice Address - Fax:281-239-0828
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36647103TM1800X
TX34747103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities