Freestate Behavioral Health Associates LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

18559 Issued in MD

Legal business name

FREESTATE BEHAVIORAL HEALTH ASSOCIATES LLC

Practice address

3455 Wilkens Ave Ste 301
Baltimore, MD 21229-5214

Phone

(443) 695-7851

NPI assigned

Feb 22, 2018

Organization subpart

No

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

Authorized official

Name

Dwight A Polk, LCSW-C

Title

Owner

Phone

(443) 695-7851

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519257600000",
    "number": "1487155776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE STE 301",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295214",
            "telephone_number": "443-695-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE STE 301",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295214",
            "telephone_number": "443-695-7851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREESTATE BEHAVIORAL HEALTH ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-22",
        "last_updated": "2018-02-22",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-695-7851",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "18559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN ID #",
            "identifier": "601222437",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "CR20-0007",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN #",
            "identifier": "6018524",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 INDIVIDUAL NPI #",
            "identifier": "1356866768",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JHHC ID #",
            "identifier": "338300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Yvonne Freeman, CANP
• Rachel Freeman
• Shirley Elizabeth Freeman, LCSW-C
• Vivian Delores Freeman, RN
• Ryan Michael Frees, D.C.
• Stephen L Freiberg, M.D.
• Joyce M Freidly, P.A.-C.
• Jessica Freiert
• Adam James Freitag, LMSW
• Thomas McIvor Freitag, MD

• Clinical Social Worker in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.