Healthcare Provider Details

I. General information

NPI: 1508547670
Provider Name (Legal Business Name): WENDY FRAYER, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GRACELAWN RD APT 109
AUBURN ME
04210-6556
US

IV. Provider business mailing address

10 GRACELAWN RD APT 109
AUBURN ME
04210-6556
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-8046
  • Fax: 207-344-6177
Mailing address:
  • Phone: 207-699-8046
  • Fax: 207-344-6177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WENDY LYNNE FRAYER
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 207-699-8046