Provider Demographics
NPI:1346538923
Name:FREEMAN, AMANDA C (PHD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 PASEO CAZADOR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-3022
Mailing Address - Country:US
Mailing Address - Phone:760-496-8941
Mailing Address - Fax:
Practice Address - Street 1:169 SAXONY RD STE 203
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6780
Practice Address - Country:US
Practice Address - Phone:760-496-8941
Practice Address - Fax:760-607-3023
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB219798Medicare PIN