Provider Demographics
NPI:1104148659
Name:FRASER, RONALD (MA)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:FRASER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 LAKE BARNEGAT DR
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-2103
Mailing Address - Country:US
Mailing Address - Phone:609-971-8402
Mailing Address - Fax:
Practice Address - Street 1:713 LAKE BARNEGAT DR
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2103
Practice Address - Country:US
Practice Address - Phone:609-971-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral