Provider Demographics
NPI:1578685020
Name:FRASER, GLORIA BONI (GLORIA FRASER LCSW)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:BONI
Last Name:FRASER
Suffix:
Gender:F
Credentials:GLORIA FRASER LCSW
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:BONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GLORIA FRASER
Mailing Address - Street 1:307 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2317
Mailing Address - Country:US
Mailing Address - Phone:415-397-6232
Mailing Address - Fax:415-454-9377
Practice Address - Street 1:307 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2317
Practice Address - Country:US
Practice Address - Phone:415-397-6232
Practice Address - Fax:415-454-9377
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS46271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical