Provider Demographics
NPI:1811780596
Name:FRAGALE, DEMITRIA ATHENA (BCBA, LBA-NY)
Entity type:Individual
Prefix:MRS
First Name:DEMITRIA
Middle Name:ATHENA
Last Name:FRAGALE
Suffix:
Gender:F
Credentials:BCBA, LBA-NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HUDSON TER
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-6139
Mailing Address - Country:US
Mailing Address - Phone:517-243-1041
Mailing Address - Fax:
Practice Address - Street 1:66 HUDSON TER
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-6139
Practice Address - Country:US
Practice Address - Phone:517-243-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003647103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst