Provider Demographics
NPI:1437291168
Name:FREITAG, ERIC JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOSEPH
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 1:1910 OLYMPIC BLVD SUITE 220
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:925-988-0569
Mailing Address - Fax:925-478-7930
Practice Address - Street 1:1910 OLYMPIC BLVD SUITE 220
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-988-0569
Practice Address - Fax:925-478-7930
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21325103G00000X, 103T00000X
CAPSY21325103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist