Provider Information for 1528337904
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Dr. IRINA FREDERICKS Ph.D., LMHC
Sex: Female
NPI: 1528337904
Last Updated: 2023-04-30
Certification Date: 2022-10-08
Certification Date: 2022-10-08
Details
| Name | Value | ||||||||||||
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| NPI | 1528337904 | ||||||||||||
| Enumeration Date | 2011-12-14 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4900 N OCEAN BLVD APT 1703 LAUDERDALE BY THE SEA, FL 33308-2939 United States Phone: 786-280-6663 | Fax: | ||||||||||||
| Primary Practice Address | 7901 4TH ST N STE 300 ST PETERSBURG, FL 33702-4399 United States Phone: 786-565-4109 | Fax: | ||||||||||||
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