Basic Information
Provider Information | |||||||||
NPI: | 1285611145 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FRAZER | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 285 OLD WESTPORT RD. | ||||||||
Address2: | UMASS DARTMOUTH COUNSELING CENTER | ||||||||
City: | DARTMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 027472356 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5089998650 | ||||||||
FaxNumber: | 5089999192 | ||||||||
Practice Location | |||||||||
Address1: | 285 OLD WESTPORT RD | ||||||||
Address2: | UMASS DARTMOUTH COUNSELING CENTER | ||||||||
City: | DARTMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 027472356 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5089998650 | ||||||||
FaxNumber: | 5089999192 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/30/2005 | ||||||||
LastUpdateDate: | 10/09/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 5820 | MA | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | 10218 | MA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
ID | Type | State | Issuer | Description | 5820 | 01 | MA | LMHC | OTHER | 10218 | 01 | MA | PSYCHOLOGY LICENSE | OTHER |