Provider Demographics
NPI:1013097070
Name:FREEMAN, HEATHER R (LCSW #15856)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:R
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LCSW #15856
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78347 BROOKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2737
Mailing Address - Country:US
Mailing Address - Phone:760-485-2938
Mailing Address - Fax:
Practice Address - Street 1:78347 BROOKHAVEN LN
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2737
Practice Address - Country:US
Practice Address - Phone:760-485-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS#158561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22383ZMedicare ID - Type UnspecifiedLCSW