Provider Demographics
NPI:1093770778
Name:FREEMAN, SUE A (MA, LPSYCH, LPC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MA, LPSYCH, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 FELL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3577
Mailing Address - Country:US
Mailing Address - Phone:410-342-0433
Mailing Address - Fax:410-342-1230
Practice Address - Street 1:516 KENHORST BLVD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1716
Practice Address - Country:US
Practice Address - Phone:610-775-7756
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001744101YM0800X
PAPS004917L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001474056 0002Medicaid
PA01715701OtherCAPITAL BLUE CROSS
PA0005911297OtherAETNA
PA262803OtherMHN
PA0091681000OtherAMERIHEALTH
PA0005911297OtherAETNA