Provider Demographics
NPI:1891838389
Name:FRASER, JUDITH SHARON (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:SHARON
Last Name:FRASER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 SUNSET HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-1428
Mailing Address - Country:US
Mailing Address - Phone:323-656-9800
Mailing Address - Fax:323-656-8245
Practice Address - Street 1:2386 SUNSET HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-1428
Practice Address - Country:US
Practice Address - Phone:323-656-9800
Practice Address - Fax:323-656-8245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist