Provider Demographics
NPI:1194858662
Name:FREDERIC, CARALEE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARALEE
Middle Name:
Last Name:FREDERIC
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 1:4225 APPLE HILL CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2815
Mailing Address - Country:US
Mailing Address - Phone:719-282-8803
Mailing Address - Fax:
Practice Address - Street 1:4090 CENTER PARK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-4507
Practice Address - Country:US
Practice Address - Phone:719-574-8761
Practice Address - Fax:719-574-1461
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical