Provider Demographics
NPI:1629407432
Name:DAMARI, FREDELYN
Entity Type:Individual
Prefix:
First Name:FREDELYN
Middle Name:
Last Name:DAMARI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:FREDELYN
Other - Middle Name:
Other - Last Name:ENGELBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:106 RECTOR CT
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4221
Mailing Address - Country:US
Mailing Address - Phone:201-218-6354
Mailing Address - Fax:201-384-5494
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-414-2601
Practice Address - Fax:718-863-2360
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008379-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist