Provider Demographics
NPI:1912066341
Name:FREEMAN, LAURA DENISE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:DENISE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:57 BRUCE SCUDDER RD
Mailing Address - Street 2:
Mailing Address - City:FLEISCHMANNS
Mailing Address - State:NY
Mailing Address - Zip Code:12430
Mailing Address - Country:US
Mailing Address - Phone:845-254-4494
Mailing Address - Fax:
Practice Address - Street 1:57 BRUCE SCUDDER RD
Practice Address - Street 2:
Practice Address - City:FLEISCHMANNS
Practice Address - State:NY
Practice Address - Zip Code:12430
Practice Address - Country:US
Practice Address - Phone:845-254-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04905511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY713335OtherMVP HEALTH CARE