Provider Demographics
NPI:1831421320
Name:FREEMAN, AMY (MSW, LSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1304
Mailing Address - Country:US
Mailing Address - Phone:570-823-2144
Mailing Address - Fax:570-829-5054
Practice Address - Street 1:31 W MARKET ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1304
Practice Address - Country:US
Practice Address - Phone:570-823-2144
Practice Address - Fax:570-829-5054
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125944104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker