Provider Demographics
NPI:1508989096
Name:FREEMAN, JON TYLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:TYLER
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W 55TH ST
Mailing Address - Street 2:FLOOR 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4460
Mailing Address - Country:US
Mailing Address - Phone:212-994-5100
Mailing Address - Fax:212-994-5101
Practice Address - Street 1:423 W 55TH ST
Practice Address - Street 2:FLOOR 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4460
Practice Address - Country:US
Practice Address - Phone:212-994-5100
Practice Address - Fax:212-994-5101
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014346-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical