Provider Demographics
NPI:1548224744
Name:FREDRICKSON, SUSAN M (LMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2950 PLAZA TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2825
Mailing Address - Country:US
Mailing Address - Phone:352-394-5922
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:655 W HWY 50
Practice Address - Street 2:SUITE 104
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2913
Practice Address - Country:US
Practice Address - Phone:352-394-5922
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMH 4648103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical