Provider Demographics
NPI:1336190966
Name:CHAKARA, FREEMAN M (PSYD)
Entity Type:Individual
Prefix:
First Name:FREEMAN
Middle Name:M
Last Name:CHAKARA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 OLD ROTHSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9133
Mailing Address - Country:US
Mailing Address - Phone:717-556-0149
Mailing Address - Fax:717-556-0149
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1753
Practice Address - Country:US
Practice Address - Phone:717-556-0149
Practice Address - Fax:717-556-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009409103G00000X, 103TC0700X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA680015251OtherRAILROAD MEDICARE
PA02271001OtherCAPITAL BLUE CROSS
PA1548470OtherGATEWAY MEDICARE ASSURED
PA001334567OtherHIGHMARK BLUE SHIELD
PA0018978580002Medicaid
PA1548470OtherGATEWAY MEDICARE ASSURED
PAP56460Medicare UPIN