MEDICARE: FREDERICKA EJAAD FAIRCHILD MA

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1285479188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICKA EJAAD FAIRCHILD MA

Provider Business Mailing Address
First Line	:	2701 N OCEAN BLVD APT 5B
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-7538
Country	:	US
Telephone Number	:	631-834-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 N OCEAN BLVD APT 5B
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-7538
Country	:	US
Telephone Number	:	631-834-8001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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