Provider Demographics
NPI:1225106628
Name:FREITAG, MILAM KEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MILAM
Middle Name:KEN
Last Name:FREITAG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 NEW MONTGOMERY ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3429
Mailing Address - Country:US
Mailing Address - Phone:415-522-2953
Mailing Address - Fax:415-543-4264
Practice Address - Street 1:55 NEW MONTGOMERY ST
Practice Address - Street 2:SUITE 420
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3429
Practice Address - Country:US
Practice Address - Phone:415-522-2953
Practice Address - Fax:415-543-4264
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14929103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist