Provider Demographics
NPI:1619975323
Name:FREUND, MARY LIZ (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY LIZ
Middle Name:
Last Name:FREUND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 N CAPITOL AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1261
Mailing Address - Country:US
Mailing Address - Phone:317-962-2700
Mailing Address - Fax:317-962-5039
Practice Address - Street 1:1633 N CAPITOL AVE
Practice Address - Street 2:STE 700
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1261
Practice Address - Country:US
Practice Address - Phone:317-962-2700
Practice Address - Fax:317-962-5039
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001545A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN176390PMedicare PIN
IN317190CMedicare PIN