Basic Information
| Provider Information | |||||||||
| NPI: | 1396055802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 454 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021513034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814858222 | ||||||||
| FaxNumber: | 7814858220 | ||||||||
| Practice Location | |||||||||
| Address1: | 349 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021391715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8579987096 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker | 104100000X | MA 02139-1715 | MA | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.