Provider Demographics
NPI:1073835633
Name:FREATHY, EVANGELINE E (MSW)
Entity Type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:E
Last Name:FREATHY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8928 VOLUNTEER LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3238
Mailing Address - Country:US
Mailing Address - Phone:916-368-5114
Mailing Address - Fax:916-368-5157
Practice Address - Street 1:8928 VOLUNTEER LN
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3238
Practice Address - Country:US
Practice Address - Phone:916-368-5114
Practice Address - Fax:916-368-5157
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA680002878104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker