Provider Demographics
NPI:1285754200
Name:FREEDMAN, JOAN GABRIELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:GABRIELLE
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 BRIGHTON WAY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5131
Mailing Address - Country:US
Mailing Address - Phone:310-858-8836
Mailing Address - Fax:
Practice Address - Street 1:9615 BRIGHTON WAY
Practice Address - Street 2:SUITE 420
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5131
Practice Address - Country:US
Practice Address - Phone:310-858-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13683Medicare ID - Type Unspecified