1063739076 NPI number — MARILYN SARA FREEMAN PH.D., MFT

Table of content: (NPI 1578564126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063739076 NPI number — MARILYN SARA FREEMAN PH.D., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
MARILYN
Provider Middle Name:
SARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEMAN
Provider Other First Name:
MARILYN
Provider Other Middle Name:
SARA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063739076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 AVENIDA ANACAPA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92009-9324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-436-0066
Provider Business Mailing Address Fax Number:
760-436-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9834 GENESEE AVE
Provider Second Line Business Practice Location Address:
STE. 427
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-502-5553
Provider Business Practice Location Address Fax Number:
760-436-0066
Provider Enumeration Date:
04/29/2010

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: 106H00000X , with the licence number:  MFC7750 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106H00000X . This is a "CA BOARD OF BEHAVIORAL SCIENCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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