Provider Demographics
NPI:1942694484
Name:FREEMAN, MARTIN STOKES (BA, MTH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:STOKES
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:BA, MTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:216-295-7239
Mailing Address - Fax:216-295-7240
Practice Address - Street 1:20600 CHAGRIN BLVD STE 900
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5362
Practice Address - Country:US
Practice Address - Phone:216-295-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0020668104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker