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NPI Code Detail

MEDICARE: DR. TEDDY RAY FRAKER LCSW-C, PH.D

MEDICARE: DR. TEDDY RAY FRAKER LCSW-C, PH.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker00307MD

General Provider Information

NPI Number : 1033143219
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TEDDY RAY FRAKER LCSW-C, PH.D
Provider Business Mailing Address
First Line : 112 EDITH STONE DR
Second Line :
City : ABINGDON
State : MD
Zip : 21009-1170
Country : US
Telephone Number : 410-569-8224
Fax Number : 443-625-1520
Provider Business Practice Location Address
First Line : 135 N PARKE ST
Second Line :
City : ABERDEEN
State : MD
Zip : 21001-2428
Country : US
Telephone Number : 443-625-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2007

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