MR. GARY J FREDERICKSEN LICSW
NPI 1700950557
Social Worker - Clinical in Lacey, WA

Active since November 20, 2006
4422 6TH AVE SE, LACEY, WA 98503(360) 704-7170(360) 412-4982 Get Directions Write a Review

NPPES record last updated: July 20, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Gary J Fredericksen Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. GARY J FREDERICKSEN LICSW (NPI 1700950557) is an individual clinical provider in Lacey, Washington, licensed in Washington (LW00004165) and active in the NPI registry since November 2006.

NPPES Registry Identity

NPI1700950557
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameMR. GARY J FREDERICKSENCredential: LICSW
Location Address4422 6TH AVE SELacey, WA 98503-1020
Mailing Address4422 6th Ave SeLacey, WA 98503-1020 · (360) 704-7170 · Fax (360) 412-4982
Fax(360) 412-4982
Sole ProprietorYes
Enumeration DateNovember 20, 2006
Last NPPES UpdateJuly 20, 2007
NPI 1700950557 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in WA · LW00004165
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License LW00004165 (WA)
4422 6TH AVE SE, Lacey, WA 98503

Other Identifiers 1

Medicare ID-Type Unspecified8804265WA · Medicare Id Number

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Mental Health)
4422 6TH AVE SE
LACEY, WA 98503
Registered Nurse (Psychiatric/Mental Health)
4422 6TH AVE SE
LACEY, WA 98503
Registered Nurse (Psychiatric/Mental Health)
4422 6TH AVE SE
LACEY, WA 98503
Pharmacy (Clinic Pharmacy)
4422 6TH AVE SE
LACEY, WA 98503
Psychiatry & Neurology (Psychiatry)
4422 6TH AVE SE
LACEY, WA 98503
Registered Nurse (Psychiatric/Mental Health)
4422 6TH AVE SE
LACEY, WA 98503
Counselor (Mental Health)
4422 6TH AVE SE
LACEY, WA 98503

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gary Fredericksen's NPI number?

The NPI number for Gary Fredericksen is 1700950557. It was assigned to this individual provider in the NPPES registry on November 20, 2006.

Where is Gary Fredericksen located?

Gary Fredericksen practices at 4422 6th Ave SE, Lacey, WA 98503. The listed phone number is (360) 704-7170.

What is Gary Fredericksen's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Gary Fredericksen was last updated on July 20, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.