Provider Demographics
NPI:1114363264
Name:FREDETTE, PATRICIA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:D
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VINE STREET
Mailing Address - Street 2:HUMAN RESOURCES
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:860-297-0905
Mailing Address - Fax:860-297-0931
Practice Address - Street 1:500 VINE STREET
Practice Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-297-0905
Practice Address - Fax:860-297-0931
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0072971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical