Individual
ELIZABETH R FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1100 W 21ST STREET, CLOVIS, NM 88101
(575) 769-2345
(575) 769-9013
Mailing address
1100 W 21ST STREET, CLOVIS, NM 88101
(575) 769-2345
(575) 769-9013
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-11341
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62430360
—
NM
Enumeration date
10/23/2009
Last updated
11/01/2022
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