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General NPI Number Information
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NPI Number | 1841406188
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Entity Type | Individual
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Provider Name | KENNETH L. FREDERICK LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1925 S PERIMETER RD SUITE 120
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-7122
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Country | US
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Telephone | 954-958-0988
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Fax | 954-958-3527
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Provider Business Mailing Address
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Address Line | 3868 NE 169TH ST APT 303
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-3210
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Country | US
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Telephone | 954-958-0988
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Fax | 954-958-3527
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1560
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License Number State | FL
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