Provider Demographics
NPI:1861259269
Name:FREDERICK, LAWANDA (LPCA)
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CHURCH HILL RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1194
Mailing Address - Country:US
Mailing Address - Phone:753-232-2004
Mailing Address - Fax:
Practice Address - Street 1:107 CHURCH HILL RD STE 1A
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1194
Practice Address - Country:US
Practice Address - Phone:475-323-2200
Practice Address - Fax:475-323-2201
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional