Healthcare Provider Details

I. General information

NPI: 1720260805
Provider Name (Legal Business Name): LAURA LYNNETTE FRAKEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER STREET
PAWTUCKET RI
02860-4400
US

IV. Provider business mailing address

111 BREWSTER STREET WOOD BLDG #516
PAWTUCKET RI
02860-4400
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2326
  • Fax: 401-729-2243
Mailing address:
  • Phone: 401-729-3481
  • Fax: 401-729-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8791
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS00999
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: