Provider Demographics
NPI:1811577190
Name:FREEMAN, MARK A (MS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:27 HIGH PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3318
Mailing Address - Country:US
Mailing Address - Phone:617-992-6136
Mailing Address - Fax:
Practice Address - Street 1:27 HIGH PLAIN RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3318
Practice Address - Country:US
Practice Address - Phone:617-992-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12534OtherLICENSED MENTAL HEALTH CLINICIAN