Provider Demographics
NPI:1457577975
Name:FRADIN, SASHA J (MA)
Entity Type:Individual
Prefix:MS
First Name:SASHA
Middle Name:J
Last Name:FRADIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 VIRGILIA CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3185
Mailing Address - Country:US
Mailing Address - Phone:919-981-6232
Mailing Address - Fax:
Practice Address - Street 1:NCSU PSYCHOEDUCATIONAL CLINIC
Practice Address - Street 2:CAMPUS BOX 7650
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-0001
Practice Address - Country:US
Practice Address - Phone:919-515-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2281103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical