=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851713556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIMBERLY A. FRASCA, PSY.D. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2014
-----------------------------------------------------
Last Update Date | 01/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3771 NESCONSET HWY SUITE 208A
-----------------------------------------------------
City | SOUTH SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11720-1163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-905-1254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3771 NESCONSET HWY SUITE 208A
-----------------------------------------------------
City | SOUTH SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11720-1163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-905-1254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KIMBERLY ANN FRASCA
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 631-905-1254
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 018606
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------