Provider Demographics
NPI:1376667840
Name:FRAZIER, MARJORIE ANN (MS,CASAC, LMHC)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANN
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MS,CASAC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6323
Mailing Address - Country:US
Mailing Address - Phone:315-797-1531
Mailing Address - Fax:315-797-1527
Practice Address - Street 1:2626 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6323
Practice Address - Country:US
Practice Address - Phone:315-797-1531
Practice Address - Fax:315-797-1527
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4619101YA0400X
NY000711-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health