MEDICARE: FREEDMAN MENTAL HEALTH SERVICES LLC

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	MA114131	MA

General Provider Information

NPI Number	:	1265821615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDMAN MENTAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	64 RIDGE AVE
Second Line	:
City	:	NEWTON CENTRE
State	:	MA
Zip	:	02459-2535
Country	:	US
Telephone Number	:	617-735-7044
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 AUSTIN ST STE 101
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1857
Country	:	US
Telephone Number	:	617-735-7044
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN S FREEDMAN
Credential	:	RN CNS
Telephone Number	:	617-735-7044

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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