Provider Demographics
NPI:1306946298
Name:FRAIFELD, JOAN C (MSSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:C
Last Name:FRAIFELD
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 W. MARKET S., STE. 100
Mailing Address - Street 2:TRIAD PSYCHIATRIC COUNSELING CENTER
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-4444
Mailing Address - Country:US
Mailing Address - Phone:336-632-3505
Mailing Address - Fax:336-632-3503
Practice Address - Street 1:3511 W. MARKET S., STE. 100
Practice Address - Street 2:TRIAD PSYCHIATRIC COUNSELING CENTER
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4444
Practice Address - Country:US
Practice Address - Phone:336-632-3505
Practice Address - Fax:336-632-3503
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008914486Medicaid
NC6007218Medicaid
NC2873695Medicare PIN
VA008914486Medicaid
VAS69901Medicare UPIN