Active NPI
Timothy Freeman, LCSW
- Clinical Social Worker
- Russellville, AR
National Provider Identifier
1407018534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2575-C
- Practice address
- 915 W Main St Ste D
Russellville, AR 72801-3508 - Phone
- (479) 208-5038
- NPI assigned
- Jun 30, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | |||
| Clinical Social Worker | 1041C0700X | 2575-C | AR | Primary |
Addresses
Primary practice location
915 W Main St Ste D
Russellville, AR 72801-3508
Mailing address
1903 W 2ND PL
Russellville, AR 72801-4611
Phone (479) 857-2120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2575-C | AR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1407018534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1903 W 2ND PL",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728014611",
"telephone_number": "479-857-2120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 W MAIN ST STE D",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728013508",
"telephone_number": "479-208-5038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREEMAN",
"first_name": "TIMOTHY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-30",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "2575-C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.