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NPI Code Detail

MEDICARE: MRS. ELISA FRALEY LCSW

MEDICARE:  MRS. ELISA  FRALEY  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW4901FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SW4901OTHERFLSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225105778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELISA FRALEY LCSW
Provider Business Mailing Address
First Line : 4310 METRO PKWY
Second Line : STE 205
City : FORT MYERS
State : FL
Zip : 33916-9416
Country : US
Telephone Number : 561-747-2775
Fax Number : 561-747-1881
Provider Business Practice Location Address
First Line : 4425 MILITARY TRAIL
Second Line : SUITE203
City : JUPITER
State : FL
Zip : 33458-4817
Country : US
Telephone Number : 561-383-8000
Fax Number : 561-514-1275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 01/28/2022

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Directions to “ MRS. ELISA FRALEY LCSW” Practice Location

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