Provider Demographics
NPI:1871599761
Name:FREDERICKS, NANETTE ARONE (LCSW)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:ARONE
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N MICHIGAN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1774
Mailing Address - Country:US
Mailing Address - Phone:574-936-3031
Mailing Address - Fax:866-311-5621
Practice Address - Street 1:310 N MICHIGAN ST STE 204
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1774
Practice Address - Country:US
Practice Address - Phone:574-936-3031
Practice Address - Fax:866-311-5621
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002112A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200942750AMedicaid
IN452270BMedicare ID - Type UnspecifiedPROVIDER ID