Provider Demographics
NPI:1407948698
Name:FREIBERG-DALE, EILEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:FREIBERG-DALE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CARL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1906
Mailing Address - Country:US
Mailing Address - Phone:617-795-1869
Mailing Address - Fax:617-244-0260
Practice Address - Street 1:44 MECHANIC ST STE 212
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1476
Practice Address - Country:US
Practice Address - Phone:617-795-1869
Practice Address - Fax:617-244-0260
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1003621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21396Medicare ID - Type UnspecifiedMENTAL HEALTH PROVIDER