Provider Demographics
NPI:1124657853
Name:ANNE FREED LCSW LLC
Entity type:Organization
Organization Name:ANNE FREED LCSW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:801-556-2430
Mailing Address - Street 1:4505 S WASATCH BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4755
Mailing Address - Country:US
Mailing Address - Phone:801-556-2430
Mailing Address - Fax:801-277-8800
Practice Address - Street 1:4505 S WASATCH BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-4755
Practice Address - Country:US
Practice Address - Phone:801-556-2430
Practice Address - Fax:801-277-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-04
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT47411233501OtherLICENSE NUMBER