Healthcare Provider Details

I. General information

NPI: 1598980179
Provider Name (Legal Business Name): SHARON JILL FREEDMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 VALLEY RD
UPPER MONTCLAIR NJ
07043-1881
US

IV. Provider business mailing address

66 S FULLERTON AVE APT 11
MONTCLAIR NJ
07042-2672
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-2828
  • Fax: 973-655-1578
Mailing address:
  • Phone: 973-744-2828
  • Fax: 973-655-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3751
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: