Provider Demographics
NPI:1851676233
Name:JO FREDERIC LCSW INC
Entity type:Organization
Organization Name:JO FREDERIC LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:FREDERIC
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW LCSW CSWG
Authorized Official - Phone:303-721-8999
Mailing Address - Street 1:132 SILVER FOX CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2123
Mailing Address - Country:US
Mailing Address - Phone:303-721-8999
Mailing Address - Fax:303-221-5453
Practice Address - Street 1:132 SILVER FOX CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-2123
Practice Address - Country:US
Practice Address - Phone:303-721-8999
Practice Address - Fax:303-221-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty