Provider Demographics
NPI:1407059421
Name:FEDERICO, RAE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RAE
Middle Name:R
Last Name:FEDERICO
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 1:618 MASTERSON CT
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1442
Mailing Address - Country:US
Mailing Address - Phone:609-818-1166
Mailing Address - Fax:
Practice Address - Street 1:108 STRAUBE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1448
Practice Address - Country:US
Practice Address - Phone:609-818-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ SC46057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health