Provider Demographics
NPI:1821314832
Name:FREDERICK, JENA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:M
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-5135
Mailing Address - Country:US
Mailing Address - Phone:225-892-8853
Mailing Address - Fax:504-736-8939
Practice Address - Street 1:5104 DANNEEL ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4908
Practice Address - Country:US
Practice Address - Phone:504-899-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4257101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health