Provider Demographics
NPI:1295520062
Name:FREDETTE-SUMMERS, MANON CLAIRE (LMHC)
Entity type:Individual
Prefix:
First Name:MANON
Middle Name:CLAIRE
Last Name:FREDETTE-SUMMERS
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:15 E GENESEE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2564
Mailing Address - Country:US
Mailing Address - Phone:315-520-8210
Mailing Address - Fax:
Practice Address - Street 1:15 E GENESEE ST STE 203
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2564
Practice Address - Country:US
Practice Address - Phone:315-520-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health