Healthcare Provider Details

I. General information

NPI: 1639417611
Provider Name (Legal Business Name): DONNA M FREDETTE MA, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W HIGH ST
SOMERSWORTH NH
03878-1527
US

IV. Provider business mailing address

150 W HIGH ST
SOMERSWORTH NH
03878-1527
US

V. Phone/Fax

Practice location:
  • Phone: 603-661-7403
  • Fax:
Mailing address:
  • Phone: 603-312-0814
  • Fax: 855-612-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0953
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0953
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: