Provider Demographics
NPI:1740477165
Name:FRAZIER, MARK T (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 N KENDALL DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7706
Mailing Address - Country:US
Mailing Address - Phone:305-670-9737
Mailing Address - Fax:
Practice Address - Street 1:7400 N KENDALL DR
Practice Address - Street 2:SUITE 212
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7706
Practice Address - Country:US
Practice Address - Phone:305-670-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical