Provider Demographics
NPI:1487229605
Name:FREEMAN, KATELYN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COMMERCIAL ST STE 4021
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1120
Mailing Address - Country:US
Mailing Address - Phone:603-263-9628
Mailing Address - Fax:
Practice Address - Street 1:250 COMMERCIAL ST STE 4021
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1120
Practice Address - Country:US
Practice Address - Phone:603-263-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-17-26445103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3129717Medicaid