Individual
LAURALYN FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1090 AMSTERDAM AVE, SUITE 16C, NEW YORK, NY 10025-1737
(212) 523-2965
(212) 636-1303
Mailing address
1090 AMSTERDAM AVE, SUITE 16C, NEW YORK, NY 10025-1737
(212) 523-2965
(212) 636-1303
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
186512
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01484293
—
NM
Enumeration date
07/29/2006
Last updated
05/26/2023
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