Provider Demographics
NPI:1134380801
Name:FREEMAN, LAUREL ELIZABETH (LCSW RN)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:ELIZABETH
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LCSW RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N. BROADWAY
Mailing Address - Street 2:SUITE 100,101,203
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706
Mailing Address - Country:US
Mailing Address - Phone:714-245-6881
Mailing Address - Fax:
Practice Address - Street 1:2100 N. BROADWAY
Practice Address - Street 2:SUITE 100,101,203
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706
Practice Address - Country:US
Practice Address - Phone:714-245-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85951041C0700X
CA682822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse