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

Table of content: MARILYN SARA FREEMAN PH.D., MFT (NPI 1063739076)

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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