Provider Demographics
NPI:1538287578
Name:FREDERICK, VIRGINIA LEE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LEE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HAMILTON AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2010
Mailing Address - Country:US
Mailing Address - Phone:650-324-8988
Mailing Address - Fax:650-328-6600
Practice Address - Street 1:550 HAMILTON AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2010
Practice Address - Country:US
Practice Address - Phone:650-324-8988
Practice Address - Fax:650-328-6600
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical