Provider Demographics
NPI:1962105387
Name:FREILICH, ADAM (LADC 2)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:FREILICH
Suffix:
Gender:M
Credentials:LADC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FOUNTAIN ST APT 211
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6393
Mailing Address - Country:US
Mailing Address - Phone:561-568-1315
Mailing Address - Fax:
Practice Address - Street 1:59 FOUNTAIN ST APT 211
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6393
Practice Address - Country:US
Practice Address - Phone:561-568-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)