Healthcare Provider Details

I. General information

NPI: 1689682809
Provider Name (Legal Business Name): ANNE I FREEDMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST SUITE 320
PORTLAND ME
04102-3100
US

IV. Provider business mailing address

39 WALLACE AVE
SOUTH PORTLAND ME
04106-6143
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5522
  • Fax: 207-662-5527
Mailing address:
  • Phone: 207-761-0650
  • Fax: 207-761-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC7589
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: