Provider Demographics
NPI:1154640696
Name:FREEMAN, PETER DELANDER (EDD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DELANDER
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:EDD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SELBY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6221
Mailing Address - Country:US
Mailing Address - Phone:651-414-0806
Mailing Address - Fax:651-797-3545
Practice Address - Street 1:1595 SELBY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6221
Practice Address - Country:US
Practice Address - Phone:651-414-0806
Practice Address - Fax:651-797-3545
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN059471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical