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NPI Code Detail

MEDICARE: JANICE S FREDERICKS LCSW

MEDICARE: JANICE S FREDERICKS 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 WorkerLCSW0000003418TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538185129
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE S FREDERICKS LCSW
Provider Business Mailing Address
First Line : 119 BOONE RIDGE DR
Second Line : SUITE 201
City : JOHNSON CITY
State : TN
Zip : 37615-4998
Country : US
Telephone Number : 423-282-1480
Fax Number : 423-928-1353
Provider Business Practice Location Address
First Line : 919 MEDICAL PARK DR
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-1042
Country : US
Telephone Number : 423-282-1480
Fax Number : 423-928-1353
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 05/05/2015

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Directions to “ JANICE S FREDERICKS LCSW” Practice Location

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