Doctor Name: | MRS. WILMA FREDERICK |
NPI Number: | 1255371704 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | 1570 |
Business Practice Address: | 3 Arbor View Dr Ballston Lake, NY - 120199336 |
Business Phone Number: | 5185889372 |
Business Fax Number: | |
Mailing Address: | 3 Arbor View Dr, BALLSTON LAKE |
State: | NY |
Postal Code: | 120199336 |
Phone Number: | 5185889372 |
Fax Number: | |
NPI Enumeration Date: | 06/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1570 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |