Provider Demographics
NPI:1073766200
Name:FREED, MICHAEL C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:FREED
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:DEPLOMENT HEALTH CLIN CTR AT WALTER REED AMC
Mailing Address - Street 2:BULDING 2 ROOM 3E01, 6900 GEORGIA AVE., NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0001
Mailing Address - Country:US
Mailing Address - Phone:202-356-1012
Mailing Address - Fax:
Practice Address - Street 1:DEPLOMENT HEALTH CLIN CTR AT WALTER REED AMC
Practice Address - Street 2:BULDING 2 ROOM 3E01, 6900 GEORGIA AVE., NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-356-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD04437103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518139831OtherMY GROUP PRACTICE NPI