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General NPI Number Information
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NPI Number | 1205979820
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Entity Type | Individual
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Provider Name | MARILYN FREIMUTH-BARON PHD
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 125 W 16TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-6280
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Country | US
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Telephone | 212-496-7183
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Fax |
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Provider Business Mailing Address
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Address Line | 872 MANDALAY TER
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City | DE PERE
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State | WI
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Zip | 54115-4111
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Country | US
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Telephone | 920-336-4020
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Fax | 920-983-9120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6822
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License Number State | NY
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