MEDICARE: DR. ELLYN M FREEDMAN LCSW, PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW4486	FL

General Provider Information

NPI Number	:	1245566678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLYN M FREEDMAN LCSW, PSYD

Provider Business Mailing Address
First Line	:	3180 N BAY RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3815
Country	:	US
Telephone Number	:	305-531-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 N BAY RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3815
Country	:	US
Telephone Number	:	305-531-4141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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