| Jason Fredenberg, Psychologist, Pc | |
|
370 Violet Ave Poughkeepsie NY 12601-1034 | |
| (914) 475-7763 | |
| Not Available |
| Full Name | Jason Fredenberg, Psychologist, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 370 Violet Ave, Poughkeepsie, New York |
| Authorized Official Name and Position | Jason Richard Fredenberg (PRESIDENT) |
| Authorized Official Contact | 9144757763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jason Fredenberg, Psychologist, Pc 218 Windsor Dr Hurley NY 12443-5326 Ph: (845) 339-0068 | Jason Fredenberg, Psychologist, Pc 370 Violet Ave Poughkeepsie NY 12601-1034 Ph: (914) 475-7763 |
| NPI Number | 1326373267 |
|---|---|
| Provider Enumeration Date | 10/09/2009 |
| Last Update Date | 10/09/2009 |
| Medicare PECOS PAC ID | 6507904059 |
|---|---|
| Medicare Enrollment ID | O20091104000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326373267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 015573 (New York) | Primary |
| Provider Name | Jason R Fredenberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689688285 PECOS PAC ID: 0446142475 Enrollment ID: I20040325001334 |
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