Provider Demographics
NPI:1073747119
Name:FREED, JOANNE (PHD MFT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:FREED
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 WHITSETT AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1149
Mailing Address - Country:US
Mailing Address - Phone:818-300-5629
Mailing Address - Fax:
Practice Address - Street 1:4712 WHITSETT AVE APT 9
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1149
Practice Address - Country:US
Practice Address - Phone:818-300-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT21124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist