Basic Information
| Provider Information | |||||||||
| NPI: | 1346214863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAIJO | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | LCSW, LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 4TH ST | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809075771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196300447 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7500 COCHRANE CIR. | ||||||||
| Address2: | |||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195268410 | ||||||||
| FaxNumber: | 7195260608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 992094 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.