Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003430489 |
---|---|
Provider Name | John Frasson |
First Address | Macomb, MI 48042-5410 |
Second Address | Macomb, MI 48042-5410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2020 |
Last Update Date | 02/06/2020 |