Jason R Fredenberg, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

015573 Issued in NY

Practice address

905 Greene Co Office BLDG
Greene Co Mental Health Clinic
Cairo, NY 12413-2868

Phone

(518) 622-9163

Fax

(518) 622-8592

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Clinical Psychologist

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of GreeneGroup PAC ID 9133038219, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• County of Greene

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cairo, NY
  • NPI 1255360046

  NY

  Medicare reassignment Care Compare group NPD Authorized official
• Jason Fredenberg, Psychologist, PC

  • Clinical Psychologist
  • Poughkeepsie, NY
  • NPI 1326373267

  NY

  Medicare reassignment NPD Authorized official
• County of Greene

  • Clinic/Center
  • Catskill, NY
  • NPI 1932281706
  Care Compare group NPD
• County of Greene

  • Public Health or Welfare Agency
  • Catskill, NY
  • NPI 1285745349
  Care Compare group

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689688285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 GREENE CO OFFICE BLDG",
            "address_2": "GREENE CO MENTAL HEALTH CLINIC",
            "city": "CAIRO",
            "state": "NY",
            "postal_code": "124132868",
            "telephone_number": "518-622-9163",
            "fax_number": "518-622-8592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 GREENE CO OFFICE BLDG",
            "address_2": "GREENE CO MENTAL HEALTH CLINIC",
            "city": "CAIRO",
            "state": "NY",
            "postal_code": "124132868",
            "telephone_number": "518-622-9163",
            "fax_number": "518-622-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDENBERG",
        "first_name": "JASON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "015573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NO",
            "identifier": "015573",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lissy J Escobar
• James Matthew Fauvell, LMSW
• Erin Rose Feeney, PHYSICIAN ASSISTANT
• Katie Mae Feeney, M.S. CCC-SLP, TSSLD
• Joseph James Forno Jr., R.PH.
• Kelli Rae Gilmore, LMSW, CASAC
• Dawn Amanda Gonsalves, M.D.
• Margaret M Graham, N.P.
• Roland Solomon Grayzel, LMSW
• Greene County Mental Health Clinic

• All providers in Cairo, NY
• Psychologist in New York

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.