Provider Demographics
NPI:1720260805
Name:FRAKEY, LAURA LYNNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNNETTE
Last Name:FRAKEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BREWSTER STREET
Mailing Address - Street 2:WOOD BLDG #516
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-3481
Mailing Address - Fax:401-729-2721
Practice Address - Street 1:111 BREWSTER STREET
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2326
Practice Address - Fax:401-729-2243
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8791103G00000X
RIPS00999103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI000723403OtherMEDICARE PTAN