Provider Demographics
NPI:1982293486
Name:FRAUSTO FAMILY LICENSED CLINICAL SOCIAL WORKER, PC
Entity type:Organization
Organization Name:FRAUSTO FAMILY LICENSED CLINICAL SOCIAL WORKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-491-8433
Mailing Address - Street 1:608 S MAYO AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3912
Mailing Address - Country:US
Mailing Address - Phone:323-491-8433
Mailing Address - Fax:
Practice Address - Street 1:608 S MAYO AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3912
Practice Address - Country:US
Practice Address - Phone:323-491-8433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty