Provider Demographics
NPI:1699174755
Name:FREDERICK, SCOTT (MSW)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LEINBACH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7071
Mailing Address - Country:US
Mailing Address - Phone:843-501-7001
Mailing Address - Fax:
Practice Address - Street 1:29 LEINBACH DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7071
Practice Address - Country:US
Practice Address - Phone:843-501-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical