Provider Demographics
NPI:1659118123
Name:FRASER, MASON VICTORIA
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:VICTORIA
Last Name:FRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HAUSTEN ST APT C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3069
Mailing Address - Country:US
Mailing Address - Phone:832-497-7870
Mailing Address - Fax:
Practice Address - Street 1:2444 DOLE STREET
Practice Address - Street 2:KRAUSS HALL 101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822
Practice Address - Country:US
Practice Address - Phone:808-956-9559
Practice Address - Fax:808-956-2218
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth