Active NPI
Matthew Richard Frederick, LCSW
- Clinical Social Worker
- Maumelle, AR
National Provider Identifier
1184646432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1475-C
- Practice address
- 2001 Club Manor Dr Ste J
Maumelle, AR 72113-7417 - Phone
- (501) 687-0488
- Fax
- (501) 687-0489
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1475-C | AR | Primary |
Addresses
Primary practice location
2001 Club Manor Dr Ste J
Maumelle, AR 72113-7417
Mailing address
2001 Club Manor Dr Ste J
Maumelle, AR 72113-7417
Phone (501) 687-0488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1475-C | AR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458691200000",
"number": "1184646432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 CLUB MANOR DR STE J",
"city": "MAUMELLE",
"state": "AR",
"postal_code": "721137417",
"telephone_number": "501-687-0488",
"fax_number": "501-687-0489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 CLUB MANOR DR STE J",
"city": "MAUMELLE",
"state": "AR",
"postal_code": "721137417",
"telephone_number": "501-687-0488",
"fax_number": "501-687-0489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "MATTHEW",
"middle_name": "RICHARD",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2016-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "1475-C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maumelle, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.