Provider Demographics
NPI:1407587736
Name:FREDMAN, ANIELLE M (PHD)
Entity type:Individual
Prefix:DR
First Name:ANIELLE
Middle Name:M
Last Name:FREDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:M
Other - Last Name:FREDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:473 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6672
Mailing Address - Country:US
Mailing Address - Phone:929-457-0565
Mailing Address - Fax:
Practice Address - Street 1:473 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6672
Practice Address - Country:US
Practice Address - Phone:929-457-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026599103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent