Provider Demographics
NPI:1710046529
Name:FREED, L. BRADLEY (MFT)
Entity Type:Individual
Prefix:
First Name:L.
Middle Name:BRADLEY
Last Name:FREED
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:153 SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 FIFER AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1134
Practice Address - Country:US
Practice Address - Phone:415-302-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist