Jaclyn Carol Fredriksen, PH.D., LMHC, LMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

012161 Issued in NY

Practice address

3212 County Highway 31
Cherry Valley, NY 13320-3702

Phone

(607) 677-4052

NPI assigned

Aug 26, 2021

Last updated

Aug 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 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

Mental Health Counselor

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Fredriksen Mental Health Counseling PC

  • Mental Health Counselor
  • Cherry Valley, NY
  • NPI 1396425138
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1710654777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "FORT PLAIN",
            "state": "NY",
            "postal_code": "133399998",
            "telephone_number": "607-677-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3212 COUNTY HIGHWAY 31",
            "city": "CHERRY VALLEY",
            "state": "NY",
            "postal_code": "133203702",
            "telephone_number": "607-677-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRIKSEN",
        "first_name": "JACLYN",
        "middle_name": "CAROL",
        "credential": "PH.D., LMHC, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-26",
        "last_updated": "2024-08-01",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "002156",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "012161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fmhcounseling@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3212 County Highway 31",
            "city": "Cherry Valley",
            "state": "NY",
            "country_code": "US",
            "postal_code": "133203702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cherry Valley Fire Department, Emergency Squad
• Cherry Valley-Springfield Central School
• Brandon Michael Colandrea, EMT-B
• Keri Michelle Constable, LPN
• Fredriksen Mental Health Counseling PC
• Rachael E Geyer, FNP-BC
• Kathleen M Junick, OTR
• Maureen Kuhn, F.N.P.
• Lori Miller, OTR/L
• Seth Robert Millner, LCSW

• Mental Health Counselor in Cherry Valley, NY
• Providers in Cherry Valley, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.