Provider Demographics
NPI:1821497082
Name:FRAZIER, ERNEST SR (LBS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:FRAZIER
Suffix:SR
Gender:M
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5125
Mailing Address - Country:US
Mailing Address - Phone:717-657-2080
Mailing Address - Fax:717-657-2290
Practice Address - Street 1:5351C JAYCEE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2997
Practice Address - Country:US
Practice Address - Phone:717-657-2080
Practice Address - Fax:717-657-2290
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001395103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103K00000XMedicaid