Individual
CHARLES R FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1049 BROADWAY STE 2, WEST LONG BRANCH, NJ 07764-1335
(732) 222-1100
(732) 222-1103
Mailing address
1049 BROADWAY STE 2, WEST LONG BRANCH, NJ 07764-1335
(732) 222-1100
(732) 222-1103
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
35S100267600
NJ
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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