Provider Demographics
NPI:1487429130
Name:FRAZIER, RENEE CHYRESE (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CHYRESE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MIDLAND PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3310
Mailing Address - Country:US
Mailing Address - Phone:609-954-1440
Mailing Address - Fax:
Practice Address - Street 1:212 SHORT HILLS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1040
Practice Address - Country:US
Practice Address - Phone:973-565-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061141001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical