Healthcare Provider Details

I. General information

NPI: 1659815587
Provider Name (Legal Business Name): EDDIE FREEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W LOMBARD ST
BALTIMORE MD
21201-1057
US

IV. Provider business mailing address

880 W LOMBARD ST
BALTIMORE MD
21201-1057
US

V. Phone/Fax

Practice location:
  • Phone: 361-350-6621
  • Fax:
Mailing address:
  • Phone: 361-350-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: