| Elisa Fraley, P.a. | |
|
125 W Indiantown Rd Ste 106 Jupiter FL 33458-3539 | |
| (561) 371-7722 | |
| (866) 718-3107 |
| Full Name | Elisa Fraley, P.a. |
|---|---|
| Speciality | Social Worker |
| Location | 125 W Indiantown Rd Ste 106, Jupiter, Florida |
| Authorized Official Name and Position | Elisa Ann Fraley (OWNER) |
| Authorized Official Contact | 5613717722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elisa Fraley, P.a. 116 Lighthouse Cir Apt B Tequesta FL 33469-4706 Ph: (561) 371-7722 | Elisa Fraley, P.a. 125 W Indiantown Rd Ste 106 Jupiter FL 33458-3539 Ph: (561) 371-7722 |
| NPI Number | 1912649369 |
|---|---|
| Provider Enumeration Date | 04/07/2022 |
| Last Update Date | 04/07/2022 |
| Certification Date | 04/07/2022 |
| Medicare PECOS PAC ID | 5890173439 |
|---|---|
| Medicare Enrollment ID | O20220609001991 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912649369 | NPI | - | NPPES |
| SW4901 | Other | FL | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Elisa A Fraley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225105778 PECOS PAC ID: 1557423407 Enrollment ID: I20081231000102 |
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