Provider Demographics
NPI:1205979820
Name:FREIMUTH-BARON, MARILYN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:FREIMUTH-BARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:FREIMUTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:872 MANDALAY TER
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4111
Mailing Address - Country:US
Mailing Address - Phone:920-336-4020
Mailing Address - Fax:920-983-9120
Practice Address - Street 1:125 W 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6280
Practice Address - Country:US
Practice Address - Phone:212-496-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist