MEDICARE: FREDERICK LEE JONES LMHC

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	004904-1	NY

General Provider Information

NPI Number	:	1740507516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK LEE JONES LMHC

Provider Business Mailing Address
First Line	:	40 TWILLER ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12209-2135
Country	:	US
Telephone Number	:	518-791-0494
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 TWILLER ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12209-2135
Country	:	US
Telephone Number	:	518-791-0494
Fax Number	:

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

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	10/11/2023

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