Provider Demographics
NPI:1609911080
Name:FREEDMAN, ALVIN R (PHD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:R
Last Name:FREEDMAN
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 1:3244 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4301
Mailing Address - Country:US
Mailing Address - Phone:708-914-4419
Mailing Address - Fax:
Practice Address - Street 1:2179 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-435-0998
Practice Address - Fax:937-435-7322
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical