Healthcare Provider Details

I. General information

NPI: 1689328544
Provider Name (Legal Business Name): PAULA FREEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 12/14/2024
Certification Date: 12/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DIEHL RD STE 100
NAPERVILLE IL
60563-2389
US

IV. Provider business mailing address

402 LIBERTY DR
BOLINGBROOK IL
60440-1218
US

V. Phone/Fax

Practice location:
  • Phone: 630-577-1577
  • Fax:
Mailing address:
  • Phone: 630-730-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149028216
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.105016
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: