Provider Demographics
NPI:1962912295
Name:FRAZIER, ANTWON LAWAYNE (MA)
Entity type:Individual
Prefix:MR
First Name:ANTWON
Middle Name:LAWAYNE
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111221
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0121
Mailing Address - Country:US
Mailing Address - Phone:724-408-0389
Mailing Address - Fax:
Practice Address - Street 1:5495 BRYSON DR STE 423
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0920
Practice Address - Country:US
Practice Address - Phone:239-597-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-30
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health