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NPI Code Detail

MEDICARE: MS. JACQUELINE MICHELLE FREEMAN LCSW

MEDICARE: MS. JACQUELINE MICHELLE FREEMAN LCSW
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
11041C0700XClinical Social Worker079325-1NY

General Provider Information

NPI Number : 1376785097
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE MICHELLE FREEMAN LCSW
Provider Business Mailing Address
First Line : 660 BERGEN ST
Second Line : #1C
City : BROOKLYN
State : NY
Zip : 11238-3579
Country : US
Telephone Number : 206-384-1500
Fax Number :
Provider Business Practice Location Address
First Line : 660 BERGEN ST
Second Line : 1C
City : BROOKLYN
State : NY
Zip : 11238-3579
Country : US
Telephone Number : 206-384-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2009
Last Update Date : 04/25/2013

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