Provider Demographics
NPI:1912204082
Name:DR ERIC FRAZER LLC
Entity Type:Organization
Organization Name:DR ERIC FRAZER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-400-6204
Mailing Address - Street 1:216 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2705
Mailing Address - Country:US
Mailing Address - Phone:203-400-6204
Mailing Address - Fax:
Practice Address - Street 1:216 CROWN ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2705
Practice Address - Country:US
Practice Address - Phone:203-400-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty