Provider Demographics
NPI:1851837603
Name:FREEMAN, SANDRA AIONETTE (MH 14579)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:AIONETTE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MH 14579
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 CONTEGO LN
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6512
Mailing Address - Country:US
Mailing Address - Phone:561-762-6100
Mailing Address - Fax:
Practice Address - Street 1:1041 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2402
Practice Address - Country:US
Practice Address - Phone:561-383-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 14579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health