Provider Demographics
NPI:1780854646
Name:FREEMAN, MARY EVELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EVELYN
Last Name:FREEMAN
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 1:416 N FERNCREEK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5432
Mailing Address - Country:US
Mailing Address - Phone:407-898-7798
Mailing Address - Fax:407-894-6010
Practice Address - Street 1:416 N FERNCREEK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5432
Practice Address - Country:US
Practice Address - Phone:407-898-7798
Practice Address - Fax:407-894-6010
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 88381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical