Healthcare Provider Details

I. General information

NPI: 1194957456
Provider Name (Legal Business Name): KATHERINE MARIBAH FRASER D.M.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 MYRTLE ST
SAN FRANCISCO CA
94109-6838
US

IV. Provider business mailing address

244 MYRTLE ST
SAN FRANCISCO CA
94109-6838
US

V. Phone/Fax

Practice location:
  • Phone: 415-921-6760
  • Fax:
Mailing address:
  • Phone: 415-921-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY10868
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC7616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: