Provider Demographics
NPI:1497208326
Name:FREDERICKS, KATHLEEN (LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2008
Mailing Address - Country:US
Mailing Address - Phone:267-343-9015
Mailing Address - Fax:
Practice Address - Street 1:315 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2008
Practice Address - Country:US
Practice Address - Phone:267-343-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional