Provider Demographics
NPI:1821622739
Name:STJARNE, FREDRIKA (MFA, LP)
Entity Type:Individual
Prefix:
First Name:FREDRIKA
Middle Name:
Last Name:STJARNE
Suffix:
Gender:F
Credentials:MFA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 12TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8557
Mailing Address - Country:US
Mailing Address - Phone:917-532-0687
Mailing Address - Fax:
Practice Address - Street 1:15 W 12TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8557
Practice Address - Country:US
Practice Address - Phone:917-532-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000972102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst