Provider Demographics
NPI:1326398058
Name:ENNETTE, FREDERICK C
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:ENNETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W 29TH ST
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4504
Mailing Address - Country:US
Mailing Address - Phone:212-725-7850
Mailing Address - Fax:
Practice Address - Street 1:3 W 29TH ST
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4504
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP85638102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst