Basic Information
| Provider Information | |||||||||
| NPI: | 1275014888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | BRANDON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 DELSEA DR S | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080282621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568818689 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42 DELSEA DR S | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080282621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568818689 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2018 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 37AC00423400 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.