Provider Demographics
NPI:1568456978
Name:FREED, J LAMAR (PSYD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:LAMAR
Last Name:FREED
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2150
Mailing Address - Country:US
Mailing Address - Phone:215-782-3930
Mailing Address - Fax:
Practice Address - Street 1:8125 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2150
Practice Address - Country:US
Practice Address - Phone:215-782-3930
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005778L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA660197Medicare ID - Type UnspecifiedPSYCHOLOGIST