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General NPI Number Information
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NPI Number | 1548451594
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Entity Type | Individual
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Provider Name | CHRIS V FREEMAN-CLARK L.I.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 1756 SAGAMORE RD
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City | NORTHFIELD
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State | OH
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Zip | 44067-1086
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Country | US
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Telephone | 330-467-7131
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Fax |
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Provider Business Mailing Address
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Address Line | 30 E BROAD ST 11TH FL. ATTN: TONYA FASONE
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City | COLUMBUS
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State | OH
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Zip | 43215-3414
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Country | US
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Telephone | 614-466-9930
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Fax | 614-644-9116
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0005842
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License Number State | OH
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