Provider Demographics
NPI:1043499072
Name:FRAZIER, ROBERT MIDDLETON III (MGPP, LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MIDDLETON
Last Name:FRAZIER
Suffix:III
Gender:M
Credentials:MGPP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WINDRIM AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2710
Mailing Address - Country:US
Mailing Address - Phone:215-456-2607
Mailing Address - Fax:
Practice Address - Street 1:821 HUNTINGDON PIKE STE 204
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8372
Practice Address - Country:US
Practice Address - Phone:215-914-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC010972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health