Provider Demographics
NPI:1083331094
Name:FREDA, TAYLOR AMANDA (LSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:AMANDA
Last Name:FREDA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2571
Mailing Address - Country:US
Mailing Address - Phone:484-809-4640
Mailing Address - Fax:
Practice Address - Street 1:6 DANFORTH DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-7899
Practice Address - Country:US
Practice Address - Phone:610-252-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138361104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker