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NPI Code Detail

MEDICARE: MRS. JENA M FREDERICK LCSW

MEDICARE: MRS. JENA M FREDERICK 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
1101YM0800XMental Health Counselor4257LA
21041C0700XClinical Social Worker4257LA

General Provider Information

NPI Number : 1821314832
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENA M FREDERICK LCSW
Provider Business Mailing Address
First Line : 924 DAVID DR
Second Line :
City : METAIRIE
State : LA
Zip : 70003-5135
Country : US
Telephone Number : 225-892-8853
Fax Number : 504-736-8939
Provider Business Practice Location Address
First Line : 5104 DANNEEL ST
Second Line : SUITE 4
City : NEW ORLEANS
State : LA
Zip : 70115-4908
Country : US
Telephone Number : 504-899-8003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2010
Last Update Date : 04/15/2010

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