Provider Demographics
NPI:1952982456
Name:FRASER, DIANE LYNCH (DOCTORAL)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNCH
Last Name:FRASER
Suffix:
Gender:F
Credentials:DOCTORAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FORTUNE TER STE C
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2910
Mailing Address - Country:US
Mailing Address - Phone:202-751-6519
Mailing Address - Fax:
Practice Address - Street 1:350 FORTUNE TER STE C
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2910
Practice Address - Country:US
Practice Address - Phone:202-751-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-04-1904103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst