Provider Demographics
NPI:1255371704
Name:FREDERICK, WILMA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ARBOR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9336
Mailing Address - Country:US
Mailing Address - Phone:518-588-9372
Mailing Address - Fax:
Practice Address - Street 1:3 ARBOR VIEW DR
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-9336
Practice Address - Country:US
Practice Address - Phone:518-588-9372
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health