Individual provider Active NPI

Patricia D Fredette, LCSW

  • Clinical Social Worker
  • Hartford, CT
National Provider Identifier
1114363264
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
007297 Issued in CT
Practice address
500 Vine Street
Capitol Region Mental Health Center
Hartford, CT 06112
Phone
(860) 297-0905
Fax
(860) 297-0931
NPI assigned
May 16, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 007297 CT Primary

Addresses

Primary practice location

500 Vine Street
Capitol Region Mental Health Center
Hartford, CT 06112

Mailing address

500 Vine Street
Human Resources
Hartford, CT 06112
Phone (860) 297-0905

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130809000437 CT Practitioner - Clinical Social Worker 7214179860 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of ConnecticutGroup PAC ID 8022915677, 267 clinicians

Practice addresses (Care Compare)

500 Vine St
Hartford, CT 06112-1639
Phone (860) 297-0800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007297CTMDGeriatric Physical Therapist
7297CTMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Jul 7, 2013 Accepting new patients
State of Connecticut CurrentSince Jul 7, 2013 Accepting new patients

Locations

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

500 Vine St
Hartford, CT 06112
Phone (860) 293-6400

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1114363264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 VINE STREET",
            "address_2": "HUMAN RESOURCES",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "06112",
            "telephone_number": "860-297-0905",
            "fax_number": "860-297-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 VINE STREET",
            "address_2": "CAPITOL REGION MENTAL HEALTH CENTER",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "06112",
            "telephone_number": "860-297-0905",
            "fax_number": "860-297-0931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDETTE",
        "first_name": "PATRICIA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-16",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "007297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.