MEDICARE: JESSICA BETH FRUCHTMAN MSW, LCSW, LCAS-A

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-24662	NC
2	1041C0700X	Clinical Social Worker	P012493	NC
3	1041C0700X	Clinical Social Worker	C013335	NC

General Provider Information

NPI Number	:	1316433923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BETH FRUCHTMAN MSW, LCSW, LCAS-A

Provider Business Mailing Address
First Line	:	153 AMETHYST CIR
Second Line	:
City	:	ARDEN
State	:	NC
Zip	:	28704-1135
Country	:	US
Telephone Number	:	828-279-1866
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 COVINGTON ST STE 8
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28806-2601
Country	:	US
Telephone Number	:	828-279-1866
Fax Number	:

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

Provider Enumeration Date	:	07/06/2018
Last Update Date	:	02/17/2022

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