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General NPI Number Information
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NPI Number | 1235364084
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Entity Type | Organization
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Legal Business Name | FREDERICK LEE STERN
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 108 E PATTAGANSETT RD
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City | NIANTIC
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State | CT
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Zip | 06357-2357
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Country | US
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Telephone | 860-303-3987
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Fax | 860-739-4191
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Provider Business Mailing Address
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Address Line | 108 E PATTAGANSETT RD
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City | NIANTIC
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State | CT
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Zip | 06357-2357
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Country | US
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Telephone | 860-303-3987
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Fax | 860-739-4191
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Authorized Official
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Title or Position | OWNER
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Name | FREDERICK LEE STERN
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Credential | LCSW
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Telephone | 860-303-3987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006946
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License Number State | CT
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