Individual provider Active NPI

Hannah Leigh Fraser

  • Clinical Social Worker
  • Charlotte, NC
National Provider Identifier
1043780992
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P011918 Issued in NC
Practice address
810 Tyvola Rd Ste 126
Charlotte, NC 28217-3536
Phone
(704) 566-3410
NPI assigned
Dec 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P011918 NC Primary

Addresses

Primary practice location

810 Tyvola Rd Ste 126
Charlotte, NC 28217-3536

Mailing address

810 Tyvola Rd Ste 126
Charlotte, NC 28217-3536
Phone (704) 566-3410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200320002525 NC Practitioner - Clinical Social Worker 3476981606 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P011918NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Long Center for Psychology, PLLC CurrentSince Nov 1, 2021 Accepting new patients
Serendipity Therapy, PLLC Clinical CurrentSince Feb 14, 2020 Accepting new patients
The Long Center for Psychology PastSince Nov 1, 2021 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1043780992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 TYVOLA RD STE 126",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282173536",
            "telephone_number": "704-566-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 TYVOLA RD STE 126",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282173536",
            "telephone_number": "704-566-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER",
        "first_name": "HANNAH",
        "middle_name": "LEIGH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-04",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P011918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.