Individual
DR. MYLISSA FRASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
6280 ARBORWOOD AVE, COCOA, FL 32927-4242
(321) 549-8264
Mailing address
6280 ARBORWOOD AVE, COCOA, FL 32927-4242
(321) 549-8264
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY10290
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14377878
CAQH #
FL
Enumeration date
01/08/2019
Last updated
01/08/2019
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