Healthcare Provider Details

I. General information

NPI: 1508272766
Provider Name (Legal Business Name): MEGHAN FRAWLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 N D ST
SAN BERNARDINO CA
92401-1109
US

IV. Provider business mailing address

1963 N E ST
SAN BERNARDINO CA
92405-3919
US

V. Phone/Fax

Practice location:
  • Phone: 909-708-8158
  • Fax: 909-380-7030
Mailing address:
  • Phone: 909-881-6146
  • Fax: 909-881-3479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70743
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: