Healthcare Provider Details

I. General information

NPI: 1912576331
Provider Name (Legal Business Name): BRIAN FREEMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 05/14/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MDG OPC 80 BOX 5217
APO AP
96368-5217
US

IV. Provider business mailing address

PSC 557 BOX 3230
FPO AP
96379-0033
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4780
  • Fax:
Mailing address:
  • Phone: 917-567-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP103817
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: