MEDICARE: JACQUELINE D FREEDMAN PSY. D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	35SI00603000	NJ

General Provider Information

NPI Number	:	1558835876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE D FREEDMAN PSY. D.

Provider Business Mailing Address
First Line	:	214 GODWIN AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3710
Country	:	US
Telephone Number	:	973-809-9683
Fax Number	:

Provider Business Practice Location Address
First Line	:	748 MORRIS TPKE STE 207
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-2617
Country	:	US
Telephone Number	:	973-809-9683
Fax Number	:

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

Provider Enumeration Date	:	01/21/2019
Last Update Date	:	01/21/2019

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