Individual provider Active NPI

Yolanda Michelene Fraser, LCSW

  • Clinical Social Worker
  • Fort Worth, TX
National Provider Identifier
1790037711
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
55001 Issued in TX
Practice address
3605 Varden St
Fort Worth, TX 76244-9521
Phone
(817) 983-4141
NPI assigned
Oct 15, 2012
Last updated
Oct 15, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

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 55001 TX Primary

Addresses

Primary practice location

3605 Varden St
Fort Worth, TX 76244-9521

Mailing address

3605 Varden St
Fort Worth, TX 76244-9521
Phone (817) 983-4141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20180219001783 TX Practitioner - Clinical Social Worker 2769468735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

9153 Belshire Dr
Suite 140
North Richland Hills, TX 76182-7691
Phone (817) 983-4141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005321CTMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Principal Counseling, LLC Clinical CurrentSince Feb 1, 2022 Accepting new patients
Journey Behavioral Health Center PLLC CurrentSince Dec 3, 2023 Accepting new patients
State of Connecticut Past Accepting new patients

Locations

6012 Reef Point Ln
Ste C
Fort Worth, TX 76135
Phone (682) 312-8184

9153 Belshire Dr
Ste 140
North Richland Hills, TX 76182
Phone (817) 440-4673

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1790037711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 VARDEN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762449521",
            "telephone_number": "817-983-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 VARDEN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762449521",
            "telephone_number": "817-983-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER",
        "first_name": "YOLANDA",
        "middle_name": "MICHELENE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-15",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "55001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.