Healthcare Provider Details

I. General information

NPI: 1972086122
Provider Name (Legal Business Name): PETER MACGREGOR FREEMAN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E MAIN ST
GEORGETOWN MA
01833-2101
US

IV. Provider business mailing address

58 E MAIN ST
GEORGETOWN MA
01833-2101
US

V. Phone/Fax

Practice location:
  • Phone: 978-463-1255
  • Fax: 978-463-1217
Mailing address:
  • Phone: 978-463-1255
  • Fax: 978-463-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1026265
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1026265
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerLICSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: