Mary G Freitag, PSYD LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4319 Issued in MN

Practice address

10480 Perkins Ave N
Stillwater, MN 55082-9273

Phone

(651) 357-3216

Fax

(651) 730-6657

NPI assigned

Jan 12, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1447301908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10480 PERKINS AVE N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550829273",
            "telephone_number": "651-357-3216",
            "fax_number": "651-730-6657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10480 PERKINS AVE N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550829273",
            "telephone_number": "651-357-3216",
            "fax_number": "651-730-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREITAG",
        "first_name": "MARY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PSYD LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE MHCP",
            "identifier": "014959400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "130952",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0492456",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHP",
            "identifier": "20358-02",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "028H0HA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "6151196",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "028H1FR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "1028022",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "HP 33776",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Foundation Therapies, Inc.
• Amy Catherine Fox, M.D.
• Charlie Franke
• Frederick J Hochalter OD LTD
• Allison Paulette Freeman
• Melissa Hanner Frisvold, CNM
• Lisa Marie Fritz, P.A.
• Brieana Jane Fuller
• G P Boyum MD PLLC
• Alison Gardner, PA-C

• Clinical Psychologist in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.