Provider Demographics
NPI:1861676959
Name:FRASER, DONNA (MFT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PORTOLA DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1234
Mailing Address - Country:US
Mailing Address - Phone:415-664-6500
Mailing Address - Fax:
Practice Address - Street 1:801 PORTOLA DR STE 205
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1234
Practice Address - Country:US
Practice Address - Phone:415-664-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34772106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist