Provider Demographics
NPI:1033182852
Name:AIESE, FREDERICK A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:A
Last Name:AIESE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 WHITNEY AVE
Mailing Address - Street 2:#1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5900
Mailing Address - Country:US
Mailing Address - Phone:718-755-4450
Mailing Address - Fax:718-934-7488
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 903A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:718-755-4450
Practice Address - Fax:718-934-7488
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0586151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNF3501Medicare ID - Type Unspecified