Rebecca Nicole Fredericks, LICSW, PMH-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW04082 Issued in RI

Practice address

1075 Smith St Ste 2
Providence, RI 02908-2700

Phone

(401) 369-9224

Fax

(401) 369-9275

NPI assigned

Jul 1, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

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 Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Behavioral Health Associates IncGroup PAC ID 3274798236, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Providence Behavioral Health Associates Inc

  • Clinical Psychologist
  • Providence, RI
  • NPI 1023142700
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1831935774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 SMITH ST STE 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029082700",
            "telephone_number": "401-369-9224",
            "fax_number": "401-369-9275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 SMITH ST STE 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029082700",
            "telephone_number": "401-369-9224",
            "fax_number": "401-369-9275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "REBECCA",
        "middle_name": "NICOLE",
        "credential": "LICSW, PMH-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW04082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Frazier, RN, OCN
• Marquise Frazier
• Ruquia Frechette
• Jennifer Ann Dupont Frechtte, PHD
• Kyle Frederick
• Kathryn Emily Fredette, PMHNP
• Meghan Elizabeth Fredette, MD
• Alyssa Danielle Freedman, PSY.D.
• Phyllis C Freedman, RD
• Freedom Care Ri LLC

• Clinical Social Worker in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.