Provider Demographics
NPI:1164723144
Name:FREEMAN, LAVONNE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:LAVONNE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5847
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-0847
Mailing Address - Country:US
Mailing Address - Phone:518-728-5746
Mailing Address - Fax:
Practice Address - Street 1:2452 STATE ROUTE 9 STE 302
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-4449
Practice Address - Country:US
Practice Address - Phone:518-289-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10257961041C0700X
NYR070530-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical