Provider Demographics
NPI:1790162113
Name:FREEDMAN, JODI
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT TRAINEE
Mailing Address - Street 1:22110 ROSCOE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3845
Mailing Address - Country:US
Mailing Address - Phone:818-713-8700
Mailing Address - Fax:818-713-8585
Practice Address - Street 1:22110 ROSCOE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3845
Practice Address - Country:US
Practice Address - Phone:818-713-8700
Practice Address - Fax:818-713-8585
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR361014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)