Healthcare Provider Details

I. General information

NPI: 1417201666
Provider Name (Legal Business Name): ORSLINE RUTH FRASER LCSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SMITHTOWN BLVD ST 3 UNIT 980
NESCONSET NY
11767-2081
US

IV. Provider business mailing address

251 E 52ND ST 3RD FLOOR
BROOKLYN NY
11203-3505
US

V. Phone/Fax

Practice location:
  • Phone: 917-554-2523
  • Fax: 323-544-2527
Mailing address:
  • Phone: 917-554-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80899-R
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: