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NPI Code Detail

MEDICARE: JACKIE LEE FREY LCSW

MEDICARE: JACKIE LEE FREY LCSW
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
11041C0700XClinical Social WorkerLCS8258CA

General Provider Information

NPI Number : 1013045087
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE LEE FREY LCSW
Provider Business Mailing Address
First Line : 619 PARCEL ST
Second Line :
City : MONTEREY
State : CA
Zip : 93940-1601
Country : US
Telephone Number : 831-641-0421
Fax Number :
Provider Business Practice Location Address
First Line : 1270 NATIVIDAD RD
Second Line : ROOM 200
City : SALINAS
State : CA
Zip : 93906-3122
Country : US
Telephone Number : 831-755-4510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/08/2007

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