Provider Demographics
NPI:1104980226
Name:FRAZIER, JOHN PHILLIP (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILLIP
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 NW 41ST ST STE E1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6689
Mailing Address - Country:US
Mailing Address - Phone:352-804-9979
Mailing Address - Fax:352-335-5359
Practice Address - Street 1:2631 NW 41ST ST STE E1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6689
Practice Address - Country:US
Practice Address - Phone:352-804-9979
Practice Address - Fax:352-335-5359
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-1281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1701Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION