Provider Demographics
NPI:1639139918
Name:FREEDMAN, CAROL RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:RUTH
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1511
Mailing Address - Country:US
Mailing Address - Phone:860-677-2550
Mailing Address - Fax:860-677-4978
Practice Address - Street 1:1031 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1511
Practice Address - Country:US
Practice Address - Phone:860-677-2550
Practice Address - Fax:860-677-4978
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140005508CT03OtherANTHEM BC