Individual provider Active NPI

Leslie Fraser, PH.D.

  • Clinical Psychologist
  • Fort Lauderdale, FL
National Provider Identifier
1710375134
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY9222 Issued in FL
Practice address
2900 W Cypress Creek Rd
#2
Fort Lauderdale, FL 33309-1715
Phone
(954) 915-7444
Fax
(954) 206-0372
NPI assigned
Jan 7, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY9222 FL Primary
Counseling Psychologist 103TC1900X PY9222 FL

Addresses

Primary practice location

2900 W Cypress Creek Rd
#2
Fort Lauderdale, FL 33309-1715

Mailing address

2900 W Cypress Creek Rd
#2
Fort Lauderdale, FL 33309-1715
Phone (954) 915-7444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20190723001752 FL Practitioner - Clinical Psychologist 2668708041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Optum Behavioral Care of North Carolina PCGroup PAC ID 5092120030, 175 clinicians

Practice addresses (Care Compare)

1090 S Tamiami TRL
Sarasota, FL 34236-9116
Phone (941) 363-0878

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of North Carolina, PC Counseling CurrentSince Feb 15, 2024 Accepting new patients
Optum Behavioral Care of North Carolina, P.C. CurrentSince Feb 15, 2024 Accepting new patients
TLC Recovery Center of South Florida Past Accepting new patients

Locations

7451 Wiles Rd
Ste 103
Coral Springs, FL 33067
Phone (954) 340-0173

1090 Tamiami Trl
Sarasota, FL 34236
Phone 94136308782005

4700 N Habana Ave
Ste 703
Tampa, FL 33614
Phone (813) 678-2373

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": "1420588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420588800000",
    "number": "1710375134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 W CYPRESS CREEK RD",
            "address_2": "#2",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333091715",
            "telephone_number": "954-915-7444",
            "fax_number": "954-206-0372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 W CYPRESS CREEK RD",
            "address_2": "#2",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333091715",
            "telephone_number": "954-915-7444",
            "fax_number": "954-206-0372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER",
        "first_name": "LESLIE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-07",
        "last_updated": "2015-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9222",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "FL",
            "license": "PY9222",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.