Active NPI
Patricia Ann Frederick, LCSW
- Clinical Social Worker
- Tampa, FL
National Provider Identifier
1639286065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW 3262
- Practice address
- 200 S Hoover Blvd
Suite 170
Tampa, FL 33609-3540 - Phone
- (727) 403-2217
- Fax
- (727) 217-9779
- NPI assigned
- Aug 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW 3262 | FL | Primary |
| Clinical Social Worker | 1041C0700X | 073584-1 | NY |
Addresses
Primary practice location
200 S Hoover Blvd
Suite 170
Tampa, FL 33609-3540
Mailing address
10735 Village Club Cir N
Apt 105
St Petersburg, FL 33716-3038
Phone (727) 403-2217
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW 3262 | FL | MD | Clinical Social Worker |
| 073584-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1639286065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10735 VILLAGE CLUB CIR N",
"address_2": "APT 105",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337163038",
"telephone_number": "727-403-2217",
"fax_number": "727-217-9779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S HOOVER BLVD",
"address_2": "SUITE 170",
"city": "TAMPA",
"state": "FL",
"postal_code": "336093540",
"telephone_number": "727-403-2217",
"fax_number": "727-217-9779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "PATRICIA",
"middle_name": "ANN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-23",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW 3262",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "073584-1",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.