Healthcare Provider Details

I. General information

NPI: 1922510940
Provider Name (Legal Business Name): DERRICK FREYMAN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 GREEN RD STE 160
ANN ARBOR MI
48105-1572
US

IV. Provider business mailing address

2500 LAKESHORE BLVD APT A415
YPSILANTI MI
48198-6976
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone: 734-510-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: