Provider Demographics
NPI:1144079112
Name:FREDA, CALLIE
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:FREDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CITY AVE APT J726
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3077
Mailing Address - Country:US
Mailing Address - Phone:302-559-4506
Mailing Address - Fax:
Practice Address - Street 1:728 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2941
Practice Address - Country:US
Practice Address - Phone:610-344-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health