Individual provider Active NPI

Jacob Frelick, AM

  • Clinical Social Worker
  • Washington, DC
National Provider Identifier
1669029716
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC50081142 Issued in DC
Practice address
2437 15TH St NW
Washington, DC 20009-4101
Phone
(410) 302-6677
NPI assigned
Aug 23, 2019
Last updated
Aug 23, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 22429 MD
Clinical Social Worker 1041C0700X LC50081142 DC Primary

Addresses

Primary practice location

2437 15TH St NW
Washington, DC 20009-4101

Mailing address

10743 McGregor Dr
Columbia, MD 21044-4956
Phone (410) 302-6677

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LC50081142DCMDClinical Social Worker
22429MDMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1669029716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10743 MCGREGOR DR",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210444956",
            "telephone_number": "410-302-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2437 15TH ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200094101",
            "telephone_number": "410-302-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRELICK",
        "first_name": "JACOB",
        "credential": "AM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "22429",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50081142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; 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.