Healthcare Provider Details

I. General information

NPI: 1194875294
Provider Name (Legal Business Name): MARY-MARGARET ELLEN FREIER PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VAN CEDARFIELD RD.
COLCHESTER CT
06415
US

IV. Provider business mailing address

2842 MAIN ST PMB 128
GLASTONBURY CT
06033-1077
US

V. Phone/Fax

Practice location:
  • Phone: 860-281-4318
  • Fax: 860-537-1033
Mailing address:
  • Phone: 860-281-4318
  • Fax: 860-537-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number002963
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number002963
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002963
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number002963
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002963
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number002963
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: