Provider Demographics
NPI:1346530268
Name:FREDERICKS, CHRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 ENCINA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2269
Mailing Address - Country:US
Mailing Address - Phone:805-681-0035
Mailing Address - Fax:805-681-0029
Practice Address - Street 1:5901 ENCINA RD
Practice Address - Street 2:SUITE A
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2269
Practice Address - Country:US
Practice Address - Phone:805-681-0035
Practice Address - Fax:805-681-0029
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical