Provider Demographics
NPI:1740942911
Name:FREEMAN, EUGENE DWE-MLE
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:DWE-MLE
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509D ALFRED DR APT D
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-4108
Mailing Address - Country:US
Mailing Address - Phone:215-821-5807
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST STE 1350
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4019
Practice Address - Country:US
Practice Address - Phone:215-664-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005559103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst