Provider Demographics
NPI:1710901426
Name:FREEMAN, BRUCE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ANDREW RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1929
Mailing Address - Country:US
Mailing Address - Phone:781-321-2224
Mailing Address - Fax:
Practice Address - Street 1:6 PLEASANT ST
Practice Address - Street 2:SUITE 314
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5100
Practice Address - Country:US
Practice Address - Phone:617-312-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1851284Medicaid
MA1851284Medicaid