Provider Demographics
NPI:1972891497
Name:FREEMAN, JESSICA LAUREN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LAUREN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 W OLYMPIC BLVD # 3A-300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1019
Mailing Address - Country:US
Mailing Address - Phone:213-249-9388
Mailing Address - Fax:213-389-7993
Practice Address - Street 1:1730 W OLYMPIC BLVD # 3A-300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1019
Practice Address - Country:US
Practice Address - Phone:213-249-9388
Practice Address - Fax:213-389-7993
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64642101YM0800X
NMM-083321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health