Provider Demographics
NPI:1144513615
Name:FRASER, SHIRLEY MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:FRASER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:MARIE
Other - Last Name:NAZARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:173 FARNHAM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1143
Mailing Address - Country:US
Mailing Address - Phone:860-324-4254
Mailing Address - Fax:
Practice Address - Street 1:310 HARTFORD TPKE
Practice Address - Street 2:STE 2
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4719
Practice Address - Country:US
Practice Address - Phone:860-324-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT0083521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker