Provider Demographics
NPI:1619649787
Name:FREESE, MARTHA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:FREESE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 TALBOT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3507
Mailing Address - Country:US
Mailing Address - Phone:239-233-1588
Mailing Address - Fax:
Practice Address - Street 1:8340 TALBOT ST APT 3
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3507
Practice Address - Country:US
Practice Address - Phone:239-233-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113970104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker