| Doctor Name: | MS. PAULETTE FREDERICKS |
| NPI Number: | 1629103551 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW |
| License Number: | 44SC055226600 |
| Business Practice Address: | 20000 Horizon Way, Suite 500 Mt. Laurel, NJ - 08054 |
| Business Phone Number: | 8562690019 |
| Business Fax Number: | 8564972525 |
| Mailing Address: | 525 Rt 73 North, Suite 104, MARLTON |
| State: | NJ |
| Postal Code: | 080531648 |
| Phone Number: | 8562690019 |
| Fax Number: | 8564972525 |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 11/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC055226600 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |