Healthcare Provider Details

I. General information

NPI: 1710285077
Provider Name (Legal Business Name): PENNY M FREEDMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN IGNACIO AVE
CORAL GABLES FL
33146-3030
US

IV. Provider business mailing address

8220 SW 151ST ST
PALMETTO BAY FL
33158-1958
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-8009
  • Fax:
Mailing address:
  • Phone: 305-255-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberSW345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: