Provider Demographics
NPI:1730568999
Name:FRASER, JESSICA (CASAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34570 STATE HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13782-1120
Mailing Address - Country:US
Mailing Address - Phone:607-832-5890
Mailing Address - Fax:
Practice Address - Street 1:34570 STATE HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13782-1120
Practice Address - Country:US
Practice Address - Phone:607-832-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24811101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)