Provider Demographics
NPI:1851494843
Name:NOLL, FREDERICK E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:E
Last Name:NOLL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18 CRESCENT PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5614
Mailing Address - Country:US
Mailing Address - Phone:845-294-6114
Mailing Address - Fax:845-294-4139
Practice Address - Street 1:ROUTE 17M
Practice Address - Street 2:SUITE 10
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-294-6114
Practice Address - Fax:845-294-4139
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070329-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health