Provider Demographics
NPI:1902362296
Name:ANDERSON, FREDA (LCSW)
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SAWGRASS CORPORATE PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2855
Mailing Address - Country:US
Mailing Address - Phone:754-757-9468
Mailing Address - Fax:855-509-0194
Practice Address - Street 1:1560 SAWGRASS CORPORATE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2855
Practice Address - Country:US
Practice Address - Phone:754-757-9468
Practice Address - Fax:855-509-0194
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW122071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018922500Medicaid