Healthcare Provider Details

I. General information

NPI: 1699232694
Provider Name (Legal Business Name): QUENETTE FREEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 09/30/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3597 GOLDENSTAR ST
PLUMAS LAKE CA
95961-8744
US

IV. Provider business mailing address

PO BOX 1014
OLIVEHURST CA
95961-1014
US

V. Phone/Fax

Practice location:
  • Phone: 800-588-0025
  • Fax:
Mailing address:
  • Phone: 800-588-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: