Healthcare Provider Details

I. General information

NPI: 1285861765
Provider Name (Legal Business Name): ELLEN CECELIA FREEMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 OAK ST. STERLING MEDICAL ASSOCIATES
CINCINNATI OH
45210
US

IV. Provider business mailing address

2744 KEATING ST
TEMPLE HILLS MD
20748-1512
US

V. Phone/Fax

Practice location:
  • Phone: 800-852-5678
  • Fax: 513-984-4909
Mailing address:
  • Phone: 301-423-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302472
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: