Provider Demographics
NPI:1114080868
Name:FREED, MAYA (LCSW)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:FREED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MAYA
Other - Middle Name:FREED
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:50 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1305
Mailing Address - Country:US
Mailing Address - Phone:516-295-3579
Mailing Address - Fax:516-374-2386
Practice Address - Street 1:50 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1305
Practice Address - Country:US
Practice Address - Phone:516-295-3579
Practice Address - Fax:516-374-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR019253-1 LCSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN01522Medicare ID - Type UnspecifiedPROVIDER NO