| Doctor Name: | SUSAN ANTHONY FREDRICKSON |
| NPI Number: | 1083818991 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N., M.S.N., C.S. |
| License Number: | 277918 |
| Business Practice Address: | 23-25 Bay State Court Brewster, MA - 02631 |
| Business Phone Number: | 5082407964 |
| Business Fax Number: | 5082405448 |
| Mailing Address: | 23-25 Bay State Court, BREWSTER |
| State: | MA |
| Postal Code: | 02631 |
| Phone Number: | 5082407964 |
| Fax Number: | 5082405448 |
| NPI Enumeration Date: | 06/13/2007 |
| NPI Last Update Date: | 03/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0809X |
| License Number: | 277918 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |