Provider Demographics
NPI:1134967425
Name:FRAGA, SIMONE (MSW)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:FRAGA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15464 MOORPARK ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1010
Mailing Address - Country:US
Mailing Address - Phone:510-316-4357
Mailing Address - Fax:
Practice Address - Street 1:15464 MOORPARK ST APT 8
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1010
Practice Address - Country:US
Practice Address - Phone:510-316-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical