MEDICARE: TRESA JO FREEMAN LCSW

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	SW20573	FL

General Provider Information

NPI Number	:	1598468035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRESA JO FREEMAN LCSW

Provider Business Mailing Address
First Line	:	4652 CRESCENT ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-4920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 OSBORNE RD STE E
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-8907
Country	:	US
Telephone Number	:	912-510-3420
Fax Number	:

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

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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