1093770778 NPI number — SUE A. FREEMAN MA, L.PSYCH., LPC

Table of content: TINA ENGIDAW AKALU (NPI 1821757402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093770778 NPI number — SUE A. FREEMAN MA, L.PSYCH., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
SUE
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, L.PSYCH., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093770778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 FELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21231-3577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-342-0433
Provider Business Mailing Address Fax Number:
410-342-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 KENHORST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19611-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-775-7756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2006

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: 101YM0800X , with the licence number:  PC001744 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: PS004917L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001474056 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01715701 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005911297 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 262803 . This is a "MHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0091681000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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