Provider Demographics
NPI:1649495904
Name:FREEDLAND, SUSAN (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FREEDLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 3RD AVE
Mailing Address - Street 2:APT 12HW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3416
Mailing Address - Country:US
Mailing Address - Phone:212-876-3344
Mailing Address - Fax:
Practice Address - Street 1:100 MELROSE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6257
Practice Address - Country:US
Practice Address - Phone:203-869-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00690103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist