Provider Demographics
NPI:1972554640
Name:FRAZIER, MARY ELLEN (PSY D)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 ANCHOR RODE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2739
Mailing Address - Country:US
Mailing Address - Phone:239-643-9889
Mailing Address - Fax:239-643-7074
Practice Address - Street 1:834 ANCHOR RODE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2739
Practice Address - Country:US
Practice Address - Phone:239-643-9889
Practice Address - Fax:239-643-7074
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 0038103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist