Provider Demographics
NPI:1386857506
Name:FREED, DAVID MATTHEW (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:FREED
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 1:1180 CROSS ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2924
Mailing Address - Country:US
Mailing Address - Phone:503-362-9357
Mailing Address - Fax:503-362-9424
Practice Address - Street 1:1180 CROSS ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2924
Practice Address - Country:US
Practice Address - Phone:503-362-9357
Practice Address - Fax:503-362-9424
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1477103T00000X, 103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278094Medicaid
OR278094Medicaid