Provider Demographics
NPI:1255660510
Name:FREDETTE, DENISE RAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RAE
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:RAE
Other - Last Name:FREDETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:114 MORNINGSIDE DR
Mailing Address - Street 2:APT. 45
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6007
Mailing Address - Country:US
Mailing Address - Phone:631-747-2397
Mailing Address - Fax:
Practice Address - Street 1:114 MORNINGSIDE DR
Practice Address - Street 2:APT. 45
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6007
Practice Address - Country:US
Practice Address - Phone:646-298-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093202-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical