Provider Demographics
NPI:1407638141
Name:FREDRICK, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FREDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85-5 FERNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5434
Mailing Address - Country:US
Mailing Address - Phone:610-731-9612
Mailing Address - Fax:
Practice Address - Street 1:1100 MAIN ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19015-2611
Practice Address - Country:US
Practice Address - Phone:610-447-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health