Provider Demographics
NPI:1174958250
Name:HODGES, FREDRICK DOUGLAS (LCSW, CASAC-G)
Entity type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:DOUGLAS
Last Name:HODGES
Suffix:
Gender:M
Credentials:LCSW, CASAC-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3398 WAYNE AVE
Mailing Address - Street 2:#C42
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2417
Mailing Address - Country:US
Mailing Address - Phone:347-964-6704
Mailing Address - Fax:347-326-6409
Practice Address - Street 1:3398 WAYNE AVE
Practice Address - Street 2:#C42
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2417
Practice Address - Country:US
Practice Address - Phone:347-964-6704
Practice Address - Fax:347-326-6409
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0781441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical