Provider Demographics
NPI:1548930720
Name:FREDERICK, LINDA DOBARD (LMFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:DOBARD
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 KILLDEER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4313
Mailing Address - Country:US
Mailing Address - Phone:504-919-5362
Mailing Address - Fax:504-353-8506
Practice Address - Street 1:2301 KILLDEER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4313
Practice Address - Country:US
Practice Address - Phone:503-919-5362
Practice Address - Fax:504-353-8506
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALMT420106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist