MEDICARE: MADELINE FREE PHD, MSE, MS

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

General Provider Information

NPI Number	:	1952031882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE FREE PHD, MSE, MS

Provider Business Mailing Address
First Line	:	66 W MOUNT PLEASANT AVE STE 206
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 W MOUNT PLEASANT AVE STE 206
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2930
Country	:	US
Telephone Number	:	973-251-2228
Fax Number	:

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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