Provider Demographics
NPI:1538879671
Name:FREDERICK, JESSICA MARIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIA
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 1:192 ASH CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6041
Mailing Address - Country:US
Mailing Address - Phone:720-303-3131
Mailing Address - Fax:
Practice Address - Street 1:3520 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3303
Practice Address - Country:US
Practice Address - Phone:720-303-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099287501041C0700X
NY0884021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical