Provider Demographics
NPI:1053479915
Name:COREY, FREEMAN R (LCSW, LADC, CCS)
Entity Type:Individual
Prefix:MR
First Name:FREEMAN
Middle Name:R
Last Name:COREY
Suffix:
Gender:M
Credentials:LCSW, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 RIVERSIDE ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1070
Mailing Address - Country:US
Mailing Address - Phone:207-871-1211
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:7 HATCH DR
Practice Address - Street 2:SUITE 240
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2159
Practice Address - Country:US
Practice Address - Phone:207-498-2400
Practice Address - Fax:207-498-2400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC901101YA0400X
MECCS3537101YA0400X
MELC37441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098153OtherANTHEM BCBS NUMBER
ME431586399Medicaid