Provider Demographics
NPI:1487249496
Name:FRASER, ROBIN CHESTER (LCSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:CHESTER
Last Name:FRASER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BLAZEWOOD
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1863
Mailing Address - Country:US
Mailing Address - Phone:949-353-7910
Mailing Address - Fax:888-507-7087
Practice Address - Street 1:67 BLAZEWOOD
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1863
Practice Address - Country:US
Practice Address - Phone:949-353-7910
Practice Address - Fax:888-507-7087
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA22235101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22235OtherLICENSED SOCIAL WORKER