Elizabeth R Frederick, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C-11341 Issued in NM

Practice address

1100 W 21St Street
Clovis, NM 88101

Phone

(575) 769-2345

Fax

(575) 769-9013

NPI assigned

Oct 23, 2009

Last updated

Nov 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1073849246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 W 21ST STREET",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "88101",
            "telephone_number": "575-769-2345",
            "fax_number": "575-769-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W 21ST STREET",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "88101",
            "telephone_number": "575-769-2345",
            "fax_number": "575-769-9013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "ELIZABETH",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-23",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-11341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62430360",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kelsey Jackson Fredericks, LAT, ATC
• Maria M. Fredlund
• Viliami Fukofuka
• Chantilly Fulgham
• Heather D Fullerton, M.S., CFY-SLP

• Clinical Social Worker in Clovis, NM
• Providers in Clovis, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.