Individual
AMY FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
490B W ZIA RD, SUITE 4, SANTA FE, NM 87505-7008
(505) 913-3820
(505) 913-3829
Mailing address
490B W ZIA RD, SUITE 4, SANTA FE, NM 87505-7008
(505) 913-3820
(505) 913-3829
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-07517
NM
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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