MEDICARE: DR. JOANNE FREDERICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC3332	MD
2	101YM0800X	Mental Health Counselor	DC-PRC13962	DC

General Provider Information

NPI Number	:	1215649926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE FREDERICK

Provider Business Mailing Address
First Line	:	6905 MALACHITE PL
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-1886
Country	:	US
Telephone Number	:	301-257-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	6905 MALACHITE PL
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-1886
Country	:	US
Telephone Number	:	301-257-3886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2022
Last Update Date	:	12/14/2022

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Directions to “ DR. JOANNE FREDERICK ” Practice Location

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