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General NPI Number Information
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NPI Number | 1336594258
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Entity Type | Organization
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Legal Business Name | TRACEY FRAY LCSW
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 5104 N LOCKWOOD RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34234-3311
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Country | US
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Telephone | 810-824-8516
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Fax | 941-343-2743
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Provider Business Mailing Address
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Address Line | 29184 ORANGEWOOD ST
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City | PUNTA GORDA
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State | FL
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Zip | 33982-8557
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Country | US
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Telephone | 810-824-8516
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Fax | 941-343-2743
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Authorized Official
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Title or Position | LCSW
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Name | TRACEY FRAY
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Credential |
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Telephone | 810-824-8516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 117445
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License Number State | FL
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