Provider Demographics
NPI:1154502953
Name:FREEMAN, CAROLE BEVERLY (MFTI)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:BEVERLY
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N CEDAR ST
Mailing Address - Street 2:#102
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3776
Mailing Address - Country:US
Mailing Address - Phone:818-545-7919
Mailing Address - Fax:
Practice Address - Street 1:2701 OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5200
Practice Address - Country:US
Practice Address - Phone:310-392-9474
Practice Address - Fax:310-392-7341
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF50753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist