Individual
DR. JASON R FREDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
905 GREENE CO OFFICE BLDG, GREENE CO MENTAL HEALTH CLINIC, CAIRO, NY 12413-2868
(518) 622-9163
(518) 622-8592
Mailing address
905 GREENE CO OFFICE BLDG, GREENE CO MENTAL HEALTH CLINIC, CAIRO, NY 12413-2868
(518) 622-9163
(518) 622-8592
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
015573
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015573
LICENSE NO
NY
Enumeration date
07/28/2006
Last updated
07/08/2007
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