Provider Demographics
NPI:1215249636
Name:FRAILS, JEFFREY T (BA, ADV CASAC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:T
Last Name:FRAILS
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Gender:M
Credentials:BA, ADV CASAC
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Mailing Address - Street 1:1910 ARTHUR AVENUE - OTP
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-1645
Mailing Address - Country:US
Mailing Address - Phone:718-583-5150
Mailing Address - Fax:718-299-4899
Practice Address - Street 1:1910 ARTHUR AVENUE - OTP
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1645
Practice Address - Country:US
Practice Address - Phone:718-583-5150
Practice Address - Fax:718-299-4899
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY22267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)