Provider Demographics
NPI:1376222083
Name:FREEDMAN, JESSICA DOROTHY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DOROTHY
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N 9TH ST APT 6F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2002
Mailing Address - Country:US
Mailing Address - Phone:203-554-3177
Mailing Address - Fax:
Practice Address - Street 1:212 N 9TH ST APT 6F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2002
Practice Address - Country:US
Practice Address - Phone:203-554-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123670-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker