Provider Demographics
NPI:1760531255
Name:SWERDLOW-FREED, IRENE M (PSYD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:M
Last Name:SWERDLOW-FREED
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30600 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3161
Mailing Address - Country:US
Mailing Address - Phone:248-539-7777
Mailing Address - Fax:248-539-7713
Practice Address - Street 1:30600 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3161
Practice Address - Country:US
Practice Address - Phone:248-539-7777
Practice Address - Fax:248-539-7713
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F330590Medicare UPIN
MION99270Medicare ID - Type UnspecifiedPROVIDER ID