Provider Demographics
NPI:1669155131
Name:FREEMAN, JEREMY (LP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1839
Mailing Address - Country:US
Mailing Address - Phone:845-702-8044
Mailing Address - Fax:
Practice Address - Street 1:12 BEACH RD
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1307
Practice Address - Country:US
Practice Address - Phone:845-702-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001180103TP0814X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis