Provider Demographics
NPI:1659794295
Name:FRAGA LCSW & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:FRAGA LCSW & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-5785
Mailing Address - Street 1:9495 SW 72ND ST
Mailing Address - Street 2:B294
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3253
Mailing Address - Country:US
Mailing Address - Phone:305-510-9575
Mailing Address - Fax:305-424-7530
Practice Address - Street 1:9495 SW 72ND ST
Practice Address - Street 2:B294
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3253
Practice Address - Country:US
Practice Address - Phone:305-510-9575
Practice Address - Fax:305-424-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty