Provider Demographics
NPI:1538207360
Name:FREEDMAN, RAYNA S (MFT INTERN)
Entity type:Individual
Prefix:
First Name:RAYNA
Middle Name:S
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 E GOBBI ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5551
Mailing Address - Country:US
Mailing Address - Phone:707-472-2922
Mailing Address - Fax:707-462-1381
Practice Address - Street 1:9860 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:UPPER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95485-9265
Practice Address - Country:US
Practice Address - Phone:707-275-8166
Practice Address - Fax:707-275-8168
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 49146106H00000X
CA50547106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist