Provider Demographics
NPI:1619839123
Name:FREEMAN, YANIQUE (CASAC 2)
Entity type:Individual
Prefix:
First Name:YANIQUE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 AMY AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5801
Mailing Address - Country:US
Mailing Address - Phone:315-601-8881
Mailing Address - Fax:
Practice Address - Street 1:19 JOHNSON PARK
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4432
Practice Address - Country:US
Practice Address - Phone:315-734-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35269101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)