Provider Demographics
NPI:1255186987
Name:FREDA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FREDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HOPE RD STE 3B
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1273
Mailing Address - Country:US
Mailing Address - Phone:732-724-1234
Mailing Address - Fax:
Practice Address - Street 1:615 HOPE RD STE 3B
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1273
Practice Address - Country:US
Practice Address - Phone:732-724-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00777000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health