Healthcare Provider Details

I. General information

NPI: 1437349792
Provider Name (Legal Business Name): KIMBERLY ANN FRASCA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ROOSEVELT AVE
PORT JEFFERSON STATION NY
11776-3337
US

IV. Provider business mailing address

8 ROOSEVELT AVE
PORT JEFFERSON STATION NY
11776-3337
US

V. Phone/Fax

Practice location:
  • Phone: 631-905-1254
  • Fax:
Mailing address:
  • Phone: 631-905-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number018606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: