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General NPI Number Information
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NPI Number | 1003459389
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Entity Type | Individual
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Provider Name | FREDERICK STREETS
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Gender | Male
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Dates
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Enumeration Date | 10/19/2019
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Last Update Date | 10/19/2019
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Provider Practice Location Address
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Address Line | 602 NICHOLS AVE
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City | STRATFORD
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State | CT
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Zip | 06614-3925
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Country | US
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Telephone | 203-296-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 602 NICHOLS AVE
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City | STRATFORD
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State | CT
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Zip | 06614-3925
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Country | US
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Telephone | 203-296-2430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 002270
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License Number State | CT
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