Healthcare Provider Details

I. General information

NPI: 1346359403
Provider Name (Legal Business Name): ALFRED CHARLES FREDETTE MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 M ST
MERCED CA
95348-2714
US

IV. Provider business mailing address

3319 M ST
MERCED CA
95348-2714
US

V. Phone/Fax

Practice location:
  • Phone: 209-385-3585
  • Fax: 209-385-3578
Mailing address:
  • Phone: 209-385-3585
  • Fax: 209-385-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS13930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: