Provider Demographics
NPI:1760604227
Name:FRASER, PATRICIA DESIREE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DESIREE
Last Name:FRASER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 E 99TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4424
Mailing Address - Country:US
Mailing Address - Phone:718-968-4899
Mailing Address - Fax:
Practice Address - Street 1:64 E MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5955
Practice Address - Country:US
Practice Address - Phone:347-528-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0350151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical