Doctor Name: | MS. JUDITH JAN FRADENBURG |
NPI Number: | 1083924203 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW LCSW |
License Number: | C007014 |
Business Practice Address: | 2962 Youth Unlimited Dr Sophia, NC - 273508481 |
Business Phone Number: | 3368619243 |
Business Fax Number: | 3368619253 |
Mailing Address: | 2962 Youth Unlimited Dr, SOPHIA |
State: | NC |
Postal Code: | 273508481 |
Phone Number: | 3368619243 |
Fax Number: | 3368619253 |
NPI Enumeration Date: | 10/21/2010 |
NPI Last Update Date: | 10/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | C007014 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |