MEDICARE: JEFF E FREEMAS 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	87000267A	IN
2	1041C0700X	Clinical Social Worker	34002898A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M400028675	OTHER	IN	MEDICARE PIN

General Provider Information

NPI Number	:	1841235876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF E FREEMAS LCSW

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	STE 130 PROVIDER ENROLLMENT
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9670 E WASHINGTON ST STE 120
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-3051
Country	:	US
Telephone Number	:	317-865-6922
Fax Number	:	317-865-6930

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	04/28/2020

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Directions to “ JEFF E FREEMAS LCSW” Practice Location

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