Provider Demographics
NPI:1467464313
Name:FRAZIER, THOMAS W II (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:FRAZIER
Suffix:II
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 1:5885 LANDERBROOK DR STE 310
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4031
Mailing Address - Country:US
Mailing Address - Phone:216-242-6079
Mailing Address - Fax:315-306-3610
Practice Address - Street 1:5885 LANDERBROOK DR STE 310
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4031
Practice Address - Country:US
Practice Address - Phone:216-242-6079
Practice Address - Fax:315-306-3610
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6229103TC0700X, 103TM1800X, 103TP2701X, 103TB0200X, 103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2684831Medicaid
OHFRCP79621Medicare PIN