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General NPI Number Information
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NPI Number | 1972839678
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Entity Type | Individual
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Provider Name | MICHAEL G FREDERICK SR. MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 1581 CAROL SUE AVE SUITE212
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City | TERRYTOWN
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State | LA
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Zip | 70056-5100
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Country | US
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Telephone | 504-762-9829
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Fax | 504-267-7289
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Provider Business Mailing Address
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Address Line | 1904 CEDARWOOD AVE
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City | TERRYTOWN
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State | LA
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Zip | 70056-2714
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Country | US
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Telephone | 504-762-9829
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Fax | 504-367-7289
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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 | 2750
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License Number State | LA
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