Provider Demographics
NPI:1659404127
Name:FREEDMAN-HARVEY, GARY (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FREEDMAN-HARVEY
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 1:909 ELECTRIC AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6336
Mailing Address - Country:US
Mailing Address - Phone:562-493-2244
Mailing Address - Fax:562-493-0644
Practice Address - Street 1:909 ELECTRIC AVE STE 202
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6336
Practice Address - Country:US
Practice Address - Phone:562-493-2244
Practice Address - Fax:562-493-0644
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY114190Medicaid
CACP11419Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST