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NPI Code Detail

MEDICARE: MR. JONATHAN FREDETTE LCSW

MEDICARE: MR. JONATHAN FREDETTE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCW018936PA

General Provider Information

NPI Number : 1730339649
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN FREDETTE LCSW
Provider Business Mailing Address
First Line : 935 FOULKROD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19124-2406
Country : US
Telephone Number : 215-831-1313
Fax Number :
Provider Business Practice Location Address
First Line : 3900 WOODLAND AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-4551
Country : US
Telephone Number : 215-823-5233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2008
Last Update Date : 01/28/2026

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