Provider Demographics
NPI:1790823367
Name:FREEMAN, DANA DAVIS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:DAVIS
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:LYNNE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:970 W MCNAB ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2172
Mailing Address - Country:US
Mailing Address - Phone:954-560-5127
Mailing Address - Fax:
Practice Address - Street 1:970 W MCNAB RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1115
Practice Address - Country:US
Practice Address - Phone:954-560-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z7495OtherBC/BS
Z7495OtherBC/BS