John Allen Fredrickson, LCSW-R, LIMHP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

081187 Issued in NY

Practice address

242 W 30TH St RM 602
New York, NY 10001-4954

Phone

(917) 936-7509

NPI assigned

Aug 9, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1023323557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8330 LOVELAND DR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681241310",
            "telephone_number": "917-936-7509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 W 30TH ST RM 602",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100014954",
            "telephone_number": "917-936-7509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10250 Regency Cir Ste 500",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681145703",
            "country_code": "US",
            "telephone_number": "917-936-7509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "JOHN",
        "middle_name": "ALLEN",
        "credential": "LCSW-R, LIMHP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-09",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "081845",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "2430",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "081187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Fredman, DC
• Rena Fredman, PSY.D.
• Michelle Lussier Fredrichsdorf
• Fredrick a. Valauri, M.D., P.C.
• Fredrick F. Jaffe, M.D., P.C.
• Lauralyn Fredrickson, MD
• Regina Fredrickson
• Fredrika Stjarne
• Fredrika Stjarne Psychoanalysis PC
• Free Form Optical Inc

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.