Provider Demographics
NPI:1437869542
Name:FIDRIC, AUDREY (CAT-LP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:FIDRIC
Suffix:
Gender:F
Credentials:CAT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 6TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3377
Mailing Address - Country:US
Mailing Address - Phone:408-904-9937
Mailing Address - Fax:
Practice Address - Street 1:448 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6945
Practice Address - Country:US
Practice Address - Phone:412-573-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist