Provider Demographics
NPI:1104305259
Name:MONU O' DONOGHUE, FREDA K (LISW)
Entity type:Individual
Prefix:
First Name:FREDA
Middle Name:K
Last Name:MONU O' DONOGHUE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:FREDA
Other - Middle Name:K
Other - Last Name:O' DONOGHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 PACIFIC AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1903
Mailing Address - Country:US
Mailing Address - Phone:360-782-1700
Mailing Address - Fax:360-782-1701
Practice Address - Street 1:555 PACIFIC AVE STE 202
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1903
Practice Address - Country:US
Practice Address - Phone:360-782-1700
Practice Address - Fax:360-782-1701
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33622101YA0400X
IL149.0205441041C0700X
WALW610265691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)