Most Relevant Information
Provider Data
| NPI Number: | 1003459389 |
| Provider Name: | FREDERICK STREETS |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP1600X |
| Specialty: | Counselor |
| License Number: | 002270 |
Most Important Dates
| Enumeration Date: | 10/19/2019 |
| Last Updated: | 10/19/2019 |
Provider Practice Location
602 NICHOLS AVE
STRATFORD
CT
066143925
Practice Location Phone/Fax
| Phone: | 2032962430 |
| Fax: |
Provider Mailing Location
602 NICHOLS AVE
STRATFORD
CT
066143925
Provider Mailing Phone/Fax
| Phone: | 2032962430 |
| Fax: |