1104998178 NPI number — NORINE FREEDMAN M.A. , L.C.P.C.

Table of content: NORINE FREEDMAN M.A. , L.C.P.C. (NPI 1104998178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104998178 NPI number — NORINE FREEDMAN M.A. , L.C.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEDMAN
Provider First Name:
NORINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A. , L.C.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEDMAN
Provider Other First Name:
NICKY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. , L.C.P.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104998178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
929 FOUNTAIN VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-4860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-267-8282
Provider Business Mailing Address Fax Number:
847-267-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 FOUNTAIN VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEERFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-291-1900
Provider Business Practice Location Address Fax Number:
847-267-8383
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180-001653 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001622485 . This is a "BCBSIL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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