Individual
MAKENNA NICOLE FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHC-LP
Contact information
Practice address
115 DELAFIELD ST, POUGHKEEPSIE, NY 12601-1749
(845) 240-7707
Mailing address
15 FORTUNE RD W, MIDDLETOWN, NY 10941-1625
(845) 692-4454
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
P139954
NY
Other
Enumeration date
01/16/2026
Last updated
01/16/2026
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