MEDICARE: DR. MICHAEL BRUCE FREEDMAN LSCW-C

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	11208	MD
2	1041C0700X	Clinical Social Worker	11208	MD

General Provider Information

NPI Number	:	1881925584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRUCE FREEDMAN LSCW-C

Provider Business Mailing Address
First Line	:	6109 STUART AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-4021
Country	:	US
Telephone Number	:	410-790-8433
Fax Number	:

Provider Business Practice Location Address
First Line	:	6109 STUART AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-4021
Country	:	US
Telephone Number	:	410-790-8433
Fax Number	:

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

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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