Provider Demographics
NPI:1144282864
Name:FREDERICK, AQUILLA (MBA, LMSW)
Entity type:Individual
Prefix:MS
First Name:AQUILLA
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MBA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1475
Mailing Address - Country:US
Mailing Address - Phone:212-421-0473
Mailing Address - Fax:212-644-9803
Practice Address - Street 1:240 E 59TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1475
Practice Address - Country:US
Practice Address - Phone:212-421-0473
Practice Address - Fax:212-644-9803
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR062257-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical