Provider Demographics
NPI:1063739076
Name:FREEMAN, MARILYN SARA (PHD, MFT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:SARA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:DR
Other - First Name:MARILYN
Other - Middle Name:SARA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 AVENIDA ANACAPA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9324
Mailing Address - Country:US
Mailing Address - Phone:760-436-0066
Mailing Address - Fax:760-436-0066
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:STE. 427
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-502-5553
Practice Address - Fax:760-436-0066
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC7750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherCA BOARD OF BEHAVIORAL SCIENCE