Healthcare Provider Details

I. General information

NPI: 1366126104
Provider Name (Legal Business Name): JENN FREDETTE PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 MILKSHED PL
ELKRIDGE MD
21075-6130
US

IV. Provider business mailing address

7860 MILKSHED PL
ELKRIDGE MD
21075-6130
US

V. Phone/Fax

Practice location:
  • Phone: 301-509-9768
  • Fax:
Mailing address:
  • Phone: 301-509-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER FREDETTE
Title or Position: OWNER
Credential: MA, M.DIV, LCPC
Phone: 301-509-9768