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General NPI Number Information
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NPI Number | 1366924870
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Entity Type | Individual
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Provider Name | SIERRA FREDERICK LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 3C KINGS ISLE LN
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City | MECHANICVILLE
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State | NY
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Zip | 12118-3144
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Country | US
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Telephone | 518-952-9032
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Fax |
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Provider Business Mailing Address
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Address Line | 3C KINGS ISLE LN
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City | MECHANICVILLE
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State | NY
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Zip | 12118-3144
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Country | US
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Telephone | 518-932-4410
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104280-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 092535
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License Number State | NY
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