Healthcare Provider Details

I. General information

NPI: 1780854646
Provider Name (Legal Business Name): MARY EVELYN FREEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N FERNCREEK AVE
ORLANDO FL
32803-5432
US

IV. Provider business mailing address

416 N FERNCREEK AVE
ORLANDO FL
32803-5432
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-7798
  • Fax: 407-894-6010
Mailing address:
  • Phone: 407-898-7798
  • Fax: 407-894-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 8838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: