Provider Demographics
NPI:1588960546
Name:FRAZIER, DEBORA (ACSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S WALNUT ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-6128
Mailing Address - Country:US
Mailing Address - Phone:812-334-4437
Mailing Address - Fax:
Practice Address - Street 1:205 S WALNUT ST
Practice Address - Street 2:SUITE 19
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6128
Practice Address - Country:US
Practice Address - Phone:812-334-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001354A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical