Provider Demographics
NPI:1417100546
Name:FREDERICKS, CYNTHIA M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CLARISSA DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3712
Mailing Address - Country:US
Mailing Address - Phone:516-921-4968
Mailing Address - Fax:516-921-4968
Practice Address - Street 1:19 CLARISSA DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3712
Practice Address - Country:US
Practice Address - Phone:516-921-4968
Practice Address - Fax:516-921-4968
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069659104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker