Provider Demographics
NPI:1912062688
Name:CRADEN, FREDERICK (LCSW)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:CRADEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:CREDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:54 NATHAN HALE DR
Mailing Address - Street 2:48A
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7022
Mailing Address - Country:US
Mailing Address - Phone:631-827-2869
Mailing Address - Fax:
Practice Address - Street 1:54 NATHAN HALE DR
Practice Address - Street 2:48A
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7022
Practice Address - Country:US
Practice Address - Phone:631-827-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0278381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical