Healthcare Provider Details

I. General information

NPI: 1588621122
Provider Name (Legal Business Name): JEREMY DYLAN FREUND NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COMPUTER DR STE 301
WESTBOROUGH MA
01581-1790
US

IV. Provider business mailing address

130 MARSHALL RD
LOWELL MA
01852-5130
US

V. Phone/Fax

Practice location:
  • Phone: 617-420-5316
  • Fax:
Mailing address:
  • Phone: 978-671-9160
  • Fax: 978-671-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number263052
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN263052
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: