Provider Demographics
NPI:1407589914
Name:FREITAG, STEPHANIE
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:FREITAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BEACHMONT TER
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4617
Mailing Address - Country:US
Mailing Address - Phone:973-979-7069
Mailing Address - Fax:
Practice Address - Street 1:276 FIFTH AVE
Practice Address - Street 2:STE 704 PMB 18
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:973-922-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4238103TC0700X
NY025014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE