Provider Demographics
NPI:1063007102
Name:FREDERICK, CASEY C (LCPC, LCPAT, LPC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:C
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LCPC, LCPAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1552
Mailing Address - Country:US
Mailing Address - Phone:814-562-0224
Mailing Address - Fax:
Practice Address - Street 1:8 BROOKES AVE STE 200
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2799
Practice Address - Country:US
Practice Address - Phone:240-452-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13322101YM0800X
MDATC360101YM0800X
PAPC017187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1861036436Medicaid