Provider Demographics
NPI:1043060866
Name:FREEMAN, JACQUELIN ZOE (APCC)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:ZOE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CATALPA ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2854
Mailing Address - Country:US
Mailing Address - Phone:650-732-0407
Mailing Address - Fax:
Practice Address - Street 1:1039 GARDEN ST
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1748
Practice Address - Country:US
Practice Address - Phone:650-609-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool