MEDICARE: MICHAEL B. FREEDMAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	11208	MD
2	1041C0700X	Clinical Social Worker	11208	MD

General Provider Information

NPI Number	:	1003176009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL B. FREEDMAN PHD

Provider Business Mailing Address
First Line	:	6006 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3643
Country	:	US
Telephone Number	:	410-790-8433
Fax Number	:	443-501-3379

Provider Business Practice Location Address
First Line	:	6006 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3643
Country	:	US
Telephone Number	:	410-790-8433
Fax Number	:	443-501-3379

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL B FREEDMAN
Credential	:	PHD
Telephone Number	:	410-790-8433

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/23/2012

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