Provider Demographics
NPI:1740434752
Name:FREDERICKSON, ANNE (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:FREDERICKSON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2732
Mailing Address - Country:US
Mailing Address - Phone:518-588-8304
Mailing Address - Fax:518-477-6074
Practice Address - Street 1:2500 POND VW
Practice Address - Street 2:SUITE 102A
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9750
Practice Address - Country:US
Practice Address - Phone:518-477-6072
Practice Address - Fax:518-477-6074
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY572990941103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist