Stephanie Fredericka, LCSW
Individual provider Active NPI Clinical Social Worker · Flanders, NJ
NPI 1972074813 · NPPES record last updated Jan 26, 2021
Key facts
- NPI
- 1972074813
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 44SC05705900 (NJ)
- Practice address
- 19 Downstream Dr
Flanders, NJ 07836-9568 - Phone
- (973) 634-7772
- NPI assigned
- Dec 17, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SC05705900 | NJ | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sprout Grow Blossom LLC | Current |
Accepting new patients | |
| Shine Medical of Ca PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SC05705900 | NJ | Yes |
Addresses
Primary practice location
19 Downstream Dr
Flanders, NJ 07836-9568
Mailing address
19 Downstream Dr
Flanders, NJ 07836-9568
Phone (973) 634-7772
Other providers in Flanders, NJ
- Flanders Pediatric Dentistry, LLC
- Flanders RX LLC
- Jacob Fleischman
- Cristina Fleming
- Samantha Frank
- Rachel French
- Samuel Friedman
- Dolagy Gad
- Maryam M Ghanem
- Suma Bala Ghanta
All providers in Flanders, NJ · Clinical Social Worker in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.