Healthcare Provider Details

I. General information

NPI: 1003176009
Provider Name (Legal Business Name): MICHAEL B. FREEDMAN PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 PARK HEIGHTS AVE
BALTIMORE MD
21215-3643
US

IV. Provider business mailing address

6006 PARK HEIGHTS AVE
BALTIMORE MD
21215-3643
US

V. Phone/Fax

Practice location:
  • Phone: 410-790-8433
  • Fax: 443-501-3379
Mailing address:
  • Phone: 410-790-8433
  • Fax: 443-501-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11208
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11208
License Number StateMD

VIII. Authorized Official

Name: MICHAEL B FREEDMAN
Title or Position: OWNER
Credential: PHD
Phone: 410-790-8433