Healthcare Provider Details

I. General information

NPI: 1194151076
Provider Name (Legal Business Name): HANNAH MARIE FREEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date: 01/03/2022
Reactivation Date: 01/14/2022

III. Provider practice location address

302 W CENTRAL AVE
AVIS PA
17721
US

IV. Provider business mailing address

PO BOX 4
AVIS PA
17721
US

V. Phone/Fax

Practice location:
  • Phone: 570-995-1416
  • Fax:
Mailing address:
  • Phone: 717-514-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020999
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: