Tara Fredericks LMSW

NPI 1245417005 - Social Worker - 104100000X

NPI Details
NPI 1245417005
Gender Female
Enumeration Date 01/23/2008
Last Updated 01/23/2008
Entity Type Individual
Active Over 8 years ago
Practice Location
939 JOHNSON AVE
RONKONKOMA NY, 11779-6066, US
Phone (631) 471-7242
Fax
Business Location
939 JOHNSON AVE
RONKONKOMA NY, 11779-6066, US
Phone (631) 471-7242
Fax
Toxanomy
Taxonomy Code 104100000X
License State New York
License Number 72071728
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According to our database, Ms. Tara Fredericks LMSW NPI is 1245417005, taxonomy code is 104100000X and license number is 72071728, license state is located at New York. Tara Fredericks LMSW physically located at 939 Johnson Ave, Ronkonkoma NY, 11779-6066. NPI Number Tara Fredericks LMSW has the Individual type.

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1245417005 NPI number is provided on an as is basis without warranty of any kind. 1245417005 is maintained by the National Plan & Provider Enumeration System. The contents of Tara Fredericks LMSW are for informational purposes only.