Provider Demographics
NPI:1457587552
Name:FREEMAN, TANESHA K (LCSW)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:K
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANESHA
Other - Middle Name:K
Other - Last Name:FREEMAN-KERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 SCUPPO RD
Mailing Address - Street 2:UNIT 1101
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5305
Mailing Address - Country:US
Mailing Address - Phone:203-559-5194
Mailing Address - Fax:
Practice Address - Street 1:1 PADANARAM RD
Practice Address - Street 2:STE 144B
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4889
Practice Address - Country:US
Practice Address - Phone:203-559-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079921041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY071961-1OtherNY LICENSE