Provider Demographics
NPI:1740329838
Name:REDEKOP, FREDERICK JACOB (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JACOB
Last Name:REDEKOP
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 DIAMOND PL
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2279
Mailing Address - Country:US
Mailing Address - Phone:610-301-6454
Mailing Address - Fax:
Practice Address - Street 1:201 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1952
Practice Address - Country:US
Practice Address - Phone:610-948-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004968101Y00000X
MA6425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor