Provider Demographics
NPI:1013116649
Name:FRALICH-LESARRE, NAMASTE MONIQUE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NAMASTE
Middle Name:MONIQUE
Last Name:FRALICH-LESARRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:N
Other - Middle Name:MONIQUE
Other - Last Name:LESARRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1140 OAK ST
Mailing Address - Street 2:WESTSIDE COMMUNITY SERVICES, AJANI HOUSE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2217
Mailing Address - Country:US
Mailing Address - Phone:415-431-8252
Mailing Address - Fax:
Practice Address - Street 1:1140 OAK ST
Practice Address - Street 2:WESTSIDE COMMUNITY SERVICES, AJANI HOUSE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2217
Practice Address - Country:US
Practice Address - Phone:415-431-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily