Healthcare Provider Details

I. General information

NPI: 1942236328
Provider Name (Legal Business Name): JENNIFER SMITH FREER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WHITEMAN DR NW
ALBUQUERQUE NM
87120-2196
US

IV. Provider business mailing address

6001 WHITEMAN DR NW
ALBUQUERQUE NM
87120-2196
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1155
  • Fax: 505-717-1473
Mailing address:
  • Phone: 505-717-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC-09135
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3992-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: