Gordon Timothy Frederick, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC 36746 Issued in CA

Practice address

625 Imperial Way Ste 3
Napa, CA 94559-1343

Phone

(707) 258-2580

NPI assigned

Apr 20, 2007

Sex

Male

Sole proprietor

Yes

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, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508084203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2438 WINE COUNTRY AVE",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945582591",
            "telephone_number": "707-258-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 IMPERIAL WAY STE 3",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945591343",
            "telephone_number": "707-258-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "GORDON",
        "middle_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 36746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID",
            "identifier": "MFT367460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Franzini, DO
• Gerald Fraser, DDS
• Jake Fraser
• Kenneth Andrew Fraser, DC
• Maya Simone Frazier
• Morgan Elizabeth Frederick, RD
• Freedom Home Health LLC
• Freedom Hospice, LLC
• Brian D. Freeto, M.D.
• David Michael Freeto, M.D.

• All providers in Napa, CA
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.