Healthcare Provider Details

I. General information

NPI: 1770677296
Provider Name (Legal Business Name): REBECCA FREEDMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ONTARIO STREET
ALBANY NY
12206
US

IV. Provider business mailing address

6 STERUP DRIVE
TROY NY
12180
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5150
  • Fax:
Mailing address:
  • Phone: 518-663-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number072427-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: