Provider Demographics
NPI:1609687870
Name:FREDETTE, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MIDSTATE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1857
Mailing Address - Country:US
Mailing Address - Phone:117-977-4243
Mailing Address - Fax:
Practice Address - Street 1:23 MIDSTATE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1857
Practice Address - Country:US
Practice Address - Phone:117-977-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst