MEDICARE: DR. SHARON JILL FREEDMAN PH.D.

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	103T00000X	Psychologist	3751	NJ

General Provider Information

NPI Number	:	1598980179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON JILL FREEDMAN PH.D.

Provider Business Mailing Address
First Line	:	66 S FULLERTON AVE APT 11
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2672
Country	:	US
Telephone Number	:	973-744-2828
Fax Number	:	973-655-1578

Provider Business Practice Location Address
First Line	:	543 VALLEY RD
Second Line	:
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1881
Country	:	US
Telephone Number	:	973-744-2828
Fax Number	:	973-655-1578

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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