Provider Demographics
NPI:1528223401
Name:THE FREEDMAN GROUP OF CLINICAL SOCIAL WORKERS, PLLC
Entity Type:Organization
Organization Name:THE FREEDMAN GROUP OF CLINICAL SOCIAL WORKERS, PLLC
Other - Org Name:DIANE E. FREEDMAN, LCSW, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-R
Authorized Official - Phone:631-737-5559
Mailing Address - Street 1:2233 NESCONSET HIGHWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1000
Mailing Address - Country:US
Mailing Address - Phone:631-737-5559
Mailing Address - Fax:631-737-0001
Practice Address - Street 1:2233 NESCONSET HIGHWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1000
Practice Address - Country:US
Practice Address - Phone:631-737-5559
Practice Address - Fax:631-737-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0491161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03444382Medicaid
NYNOG661Medicare PIN
NYNOG661Medicare UPIN