Provider Demographics
NPI:1386789360
Name:FREEDENFELD, ROBERT NEIL (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:NEIL
Last Name:FREEDENFELD
Suffix:
Gender:M
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:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-0532
Mailing Address - Country:US
Mailing Address - Phone:817-312-3917
Mailing Address - Fax:817-442-9787
Practice Address - Street 1:1207 S WHITE CHAPEL BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9314
Practice Address - Country:US
Practice Address - Phone:817-312-3917
Practice Address - Fax:817-442-9787
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX957FMedicare ID - Type Unspecified