Individual
MARK DAVID FRALICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
675 E 4TH ST, BOSTON, MA 02127-3063
(857) 496-7336
(857) 496-0177
Mailing address
121 INTERVALE ST, BROCKTON, MA 02302-1761
(508) 309-2254
(617) 328-0409
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13521
MA
Other
Enumeration date
11/21/2016
Last updated
11/21/2016
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