Provider Demographics
NPI:1821752189
Name:FREEMAN, SIMIRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SIMIRA
Middle Name:
Last Name:FREEMAN
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:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-1108
Mailing Address - Country:US
Mailing Address - Phone:646-696-6551
Mailing Address - Fax:
Practice Address - Street 1:1000 RIVER RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1938
Practice Address - Country:US
Practice Address - Phone:646-696-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4033103T00000X
CA32799103T00000X
NJ35SI00636400103T00000X
NY023485103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist