MEDICARE: MS. HEATHER R FREEMAN LCSW #15856

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	1041C0700X	Clinical Social Worker	LCS#15856	CA

General Provider Information

NPI Number	:	1013097070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER R FREEMAN LCSW #15856

Provider Business Mailing Address
First Line	:	78347 BROOKHAVEN LN
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-2737
Country	:	US
Telephone Number	:	760-485-2938
Fax Number	:

Provider Business Practice Location Address
First Line	:	78347 BROOKHAVEN LN
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-2737
Country	:	US
Telephone Number	:	760-485-2938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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