Basic Information
Provider Information
NPI: 1790826626
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREEMAN
FirstName: MARGARET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1770 CEDAR ST
Address2:  
City: ROCKLEDGE
State: FL
PostalCode: 329553133
CountryCode: US
TelephoneNumber: 3216346257
FaxNumber:  
Practice Location
Address1: 1770 CEDAR ST
Address2:  
City: ROCKLEDGE
State: FL
PostalCode: 329553133
CountryCode: US
TelephoneNumber: 3216346257
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/12/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH0006225FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home