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General NPI Number Information
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NPI Number | 1366126104
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Entity Type | Organization
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Legal Business Name | JENN FREDETTE PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 7860 MILKSHED PL
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City | ELKRIDGE
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State | MD
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Zip | 21075-6130
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Country | US
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Telephone | 301-509-9768
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Fax |
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Provider Business Mailing Address
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Address Line | 7860 MILKSHED PL
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City | ELKRIDGE
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State | MD
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Zip | 21075-6130
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Country | US
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Telephone | 301-509-9768
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFER FREDETTE
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Credential | MA, M.DIV, LCPC
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Telephone | 301-509-9768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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