Provider Demographics
NPI:1992457139
Name:FRASER, ELIZABETH BROOKS
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROOKS
Last Name:FRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MARKET ST APT 306
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-3216
Mailing Address - Country:US
Mailing Address - Phone:540-497-1637
Mailing Address - Fax:
Practice Address - Street 1:7051 HEATHCOTE VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3196
Practice Address - Country:US
Practice Address - Phone:703-621-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904134861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical