Individual
KATHRYN FRASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 254-4165
(386) 254-4349
Mailing address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 254-4165
(386) 254-4349
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY5411
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PY5411
STATE MEDICAL LICENSE
FL
Enumeration date
09/25/2006
Last updated
09/03/2007
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