Provider Demographics
NPI:1437595956
Name:INDENBAUM, FREDERICK STUART (EDS, LPC)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:STUART
Last Name:INDENBAUM
Suffix:
Gender:M
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 PENN AVE
Mailing Address - Street 2:SUITE 205-206
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2100
Mailing Address - Country:US
Mailing Address - Phone:610-374-4963
Mailing Address - Fax:610-378-5403
Practice Address - Street 1:1235 PENN AVE
Practice Address - Street 2:SUITE 205-206
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2100
Practice Address - Country:US
Practice Address - Phone:610-374-4963
Practice Address - Fax:610-378-5403
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional