Provider Demographics
NPI:1639417611
Name:FREDETTE, DONNA M (MA, MLADC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:MA, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1527
Mailing Address - Country:US
Mailing Address - Phone:603-312-0814
Mailing Address - Fax:855-612-2887
Practice Address - Street 1:150 W HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1527
Practice Address - Country:US
Practice Address - Phone:603-661-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0953101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health