Provider Demographics
NPI:1316313158
Name:FRAYER, WENDY L (LCSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:FRAYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMPUS AVE
Mailing Address - Street 2:SUITES A & B
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-755-3434
Mailing Address - Fax:
Practice Address - Street 1:156 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-4147
Practice Address - Fax:207-795-4147
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC170621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001843201Medicare PIN