Provider Demographics
NPI:1922154822
Name:FREED, ELLEN L (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:L
Last Name:FREED
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SECOND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347
Mailing Address - Country:US
Mailing Address - Phone:207-622-0801
Mailing Address - Fax:207-622-6988
Practice Address - Street 1:116 SECOND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347
Practice Address - Country:US
Practice Address - Phone:207-622-0801
Practice Address - Fax:207-622-6988
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC24031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
005627OtherANTHEM
7938186OtherAETNA
005627OtherANTHEM