Provider Demographics
NPI:1689493355
Name:FREDETTE, AMY LEE (CRSW, LDAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:CRSW, LDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 THORNTON RD W
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4714
Mailing Address - Country:US
Mailing Address - Phone:603-820-2600
Mailing Address - Fax:603-621-4293
Practice Address - Street 1:700 LAKE AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2734
Practice Address - Country:US
Practice Address - Phone:603-623-6324
Practice Address - Fax:603-621-4293
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0205101YA0400X
NH1522101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)