Provider Demographics
NPI:1467013797
Name:FRAITER, HAZEL LEANNE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:LEANNE
Last Name:FRAITER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 LINDEN AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1637
Mailing Address - Country:US
Mailing Address - Phone:908-377-1628
Mailing Address - Fax:
Practice Address - Street 1:1071 VALLEY RD
Practice Address - Street 2:
Practice Address - City:STIRLING
Practice Address - State:NJ
Practice Address - Zip Code:07980-1523
Practice Address - Country:US
Practice Address - Phone:908-604-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NJ1-19-36232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst