Provider Demographics
NPI:1518368810
Name:FETRIDGE, JUSTIN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:FETRIDGE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2838
Mailing Address - Country:US
Mailing Address - Phone:914-262-8081
Mailing Address - Fax:
Practice Address - Street 1:17 HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2514
Practice Address - Country:US
Practice Address - Phone:914-262-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist