Healthcare Provider Details

I. General information

NPI: 1629698972
Provider Name (Legal Business Name): JENNIFER FREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NEW JERSEY AVE SE STE 500
WASHINGTON DC
20003-3326
US

IV. Provider business mailing address

10221 RIVER RD #61061
POTOMAC MD
20859
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-7975
  • Fax:
Mailing address:
  • Phone: 202-642-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1000320
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: