Provider Demographics
NPI:1043230055
Name:FREEBORN, VINCENZA MARGARET (LCSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:VINCENZA
Middle Name:MARGARET
Last Name:FREEBORN
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:MS
Other - First Name:VINCENZA
Other - Middle Name:MARGARET
Other - Last Name:LAGATTUTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:465B ALL ANGELS HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5639
Mailing Address - Country:US
Mailing Address - Phone:845-532-4026
Mailing Address - Fax:
Practice Address - Street 1:199 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1243
Practice Address - Country:US
Practice Address - Phone:845-532-4026
Practice Address - Fax:845-795-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0478251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300121393Medicare PIN