Provider Demographics
NPI:1437765245
Name:FRASER, SHANIECE SALLIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:SHANIECE
Middle Name:SALLIE
Last Name:FRASER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 E. 55TH ST
Mailing Address - Street 2:1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:347-615-3212
Mailing Address - Fax:
Practice Address - Street 1:921 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1393
Practice Address - Country:US
Practice Address - Phone:718-778-0485
Practice Address - Fax:718-778-1375
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108946-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health