Provider Demographics
NPI:1538928791
Name:FRASER, WAVA LEIGH
Entity type:Individual
Prefix:MS
First Name:WAVA
Middle Name:LEIGH
Last Name:FRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:WAVA
Other - Middle Name:LEIGH
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-2301
Mailing Address - Country:US
Mailing Address - Phone:781-831-0146
Mailing Address - Fax:
Practice Address - Street 1:64 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4881
Practice Address - Country:US
Practice Address - Phone:508-540-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health