Provider Demographics
NPI:1265648174
Name:SHULMAN, FREDRIC DAVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:DAVIN
Last Name:SHULMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SENATOR ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5116
Mailing Address - Country:US
Mailing Address - Phone:718-748-0114
Mailing Address - Fax:718-745-2092
Practice Address - Street 1:110 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5053
Practice Address - Country:US
Practice Address - Phone:718-745-1395
Practice Address - Fax:718-745-2092
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000401102L00000X
NY001738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst