Healthcare Provider Details

I. General information

NPI: 1851713556
Provider Name (Legal Business Name): KIMBERLY A. FRASCA, PSY.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number018606
License Number StateNY

VIII. Authorized Official

Name: DR. KIMBERLY ANN FRASCA
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 631-905-1254