Provider Demographics
NPI:1891758280
Name:FREEDSON, BETTE JONAS (LCSW)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:JONAS
Last Name:FREEDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 OLD SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1708
Mailing Address - Country:US
Mailing Address - Phone:207-384-5538
Mailing Address - Fax:
Practice Address - Street 1:88 OLD SOUTH RD
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1708
Practice Address - Country:US
Practice Address - Phone:207-384-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESWLC62221041C0700X
MA105610-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8446Medicare ID - Type Unspecified
MAP03566Medicare PIN
MAP03566Medicare ID - Type Unspecified
MEMM8846Medicare PIN