Provider Demographics
NPI:1861824690
Name:FREEMAN, JESUSA CRISTINA BACAGAN
Entity type:Individual
Prefix:MS
First Name:JESUSA CRISTINA
Middle Name:BACAGAN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESUSA CRISTINA
Other - Middle Name:BACAGAN
Other - Last Name:BADONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4315
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-0315
Mailing Address - Country:US
Mailing Address - Phone:415-264-1843
Mailing Address - Fax:
Practice Address - Street 1:2640 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3238
Practice Address - Country:US
Practice Address - Phone:415-264-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist