Provider Demographics
NPI:1699974493
Name:PEGGY FREEMAN, L.C.S.W. SC
Entity type:Organization
Organization Name:PEGGY FREEMAN, L.C.S.W. SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-677-6740
Mailing Address - Street 1:64 OLD ORCHARD SHOPPING CTR
Mailing Address - Street 2:SUITE 435
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1425
Mailing Address - Country:US
Mailing Address - Phone:847-677-6740
Mailing Address - Fax:847-677-8140
Practice Address - Street 1:64 OLD ORCHARD SHOPPING CTR
Practice Address - Street 2:SUITE 435
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-677-6740
Practice Address - Fax:847-677-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL533490Medicare PIN