Jaclyn Carol Fredriksen, PHD, LMHC, LMFT is a medicare enrolled "Counselor - Mental Health" provider in Cherry Valley, New York. Her current practice location is
3212 County Highway 31, Cherry Valley, New York. You can reach out to her office (for appointments etc.) via phone at
(607) 677-4052.
Jaclyn Carol Fredriksen is licensed to practice in New York (license number 012161) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1710654777.
Healthcare Provider's Profile
Full Name | Jaclyn Carol Fredriksen |
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Gender | Female |
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Speciality | Counselor - Mental Health |
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Location | 3212 County Highway 31, Cherry Valley, New York |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1710654777
- Provider Enumeration Date: 08/26/2021
- Last Update Date: 08/01/2024
Medicare PECOS Information:
- PECOS PAC ID: 7214388925
- Enrollment ID: I20240108000228
Medical Identifiers
Medical identifiers for Jaclyn Carol Fredriksen such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1710654777 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YM0800X | Counselor - Mental Health | 002156 (New York) | Secondary |
101YM0800X | Counselor - Mental Health | 012161 (New York) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jaclyn Carol Fredriksen allows following entities to bill medicare on her behalf.
Entity Name | Fredriksen Mental Health Counseling Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1396425138 PECOS PAC ID: 6305297003 Enrollment ID: O20240108000158 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jaclyn Carol Fredriksen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jaclyn Carol Fredriksen, PHD, LMHC, LMFT Po Box 12, Fort Plain, NY 13339-9998 Ph: (607) 677-4052 | Jaclyn Carol Fredriksen, PHD, LMHC, LMFT 3212 County Highway 31, Cherry Valley, NY 13320-3702 Ph: (607) 677-4052 |
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