MEDICARE: LORI MILLER-FREITAS LICSW

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	101YM0800X	Mental Health Counselor	1028275	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MIP07373	OTHER	MA	BLUE CROSS& BLUE SHIELD

General Provider Information

NPI Number	:	1477612208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MILLER-FREITAS LICSW

Provider Business Mailing Address
First Line	:	294 PLEASANT ST
Second Line	:	SUITE 103B
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2571
Country	:	US
Telephone Number	:	781-297-2003
Fax Number	:

Provider Business Practice Location Address
First Line	:	294 PLEASANT ST
Second Line	:	SUITE 103B
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2571
Country	:	US
Telephone Number	:	781-297-2003
Fax Number	:

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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