Provider Demographics
NPI:1316964067
Name:FRAGOZA, DENISE MARIE (MSW,LICSW,LCDP)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:MARIE
Last Name:FRAGOZA
Suffix:
Gender:
Credentials:MSW,LICSW,LCDP
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:FRAGOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW,LICSW,LCDP,CCJP
Mailing Address - Street 1:34 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3203
Mailing Address - Country:US
Mailing Address - Phone:508-324-5282
Mailing Address - Fax:401-245-5395
Practice Address - Street 1:34 2ND ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3203
Practice Address - Country:US
Practice Address - Phone:401-245-5395
Practice Address - Fax:508-678-6617
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00146101YA0400X
RIISW007191041C0700X
MA1155411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDF01667Medicaid
RI808003287Medicare PIN