Provider Demographics
NPI:1346355039
Name:FREUND, BLANCHE V (PH D)
Entity Type:Individual
Prefix:
First Name:BLANCHE
Middle Name:V
Last Name:FREUND
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12155 ROMA ROAD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2079
Mailing Address - Country:US
Mailing Address - Phone:561-523-0206
Mailing Address - Fax:561-736-4025
Practice Address - Street 1:15200 JOG ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1249
Practice Address - Country:US
Practice Address - Phone:561-523-0206
Practice Address - Fax:561-736-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5256103T00000X
FLRN2892332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59763BMedicare ID - Type Unspecified