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General NPI Number Information
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NPI Number | 1346322419
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Entity Type | Individual
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Provider Name | DANIELLE FREDRICKSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 123 HOW LANE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901
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Country | US
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Telephone | 732-993-9762
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Fax | 732-626-4544
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Provider Business Mailing Address
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Address Line | 123 HOW LN
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-3653
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Country | US
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Telephone | 732-993-9762
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Fax | 732-626-4544
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00224200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 067712-1
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License Number State | NY
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