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General NPI Number Information
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NPI Number | 1396552014
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Entity Type | Organization
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Legal Business Name | BLUE STAR INTEGRATIVE HEALTH
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 9841 WASHINGTONIAN BLVD FL 5
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5389
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Country | US
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Telephone | 240-813-9841
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Fax | 240-844-0102
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Provider Business Mailing Address
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Address Line | 9841 WASHINGTONIAN BLVD FL 5
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5389
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Country | US
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Telephone | 240-813-9841
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Fax | 240-844-0102
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. PETER JOHN FREUDENBERGER
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Credential | LCSW-C
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Telephone | 513-600-3156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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