=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649542242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE RACHEL FREEDMAN LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2012
-----------------------------------------------------
Last Update Date | 01/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3525 RESOURCE DR
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133-4733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-922-1900
-----------------------------------------------------
Fax | 410-922-6288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12076 LONG LAKE DR
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-1250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-654-8758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 15244
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------