Active NPI
Jonathan Mack Freedman, PH. D.
- Psychologist
- Bangor, ME
National Provider Identifier
1700834736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS490
- Practice address
- 15 Cross St Ste 20
Bangor, ME 04401-6356 - Phone
- (207) 498-6395
- Fax
- (855) 654-2335
- NPI assigned
- May 4, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS490 | ME | Primary |
Addresses
Primary practice location
15 Cross St Ste 20
Bangor, ME 04401-6356
Mailing address
128 Manning Mill Rd
Hampden, ME 04444-1021
Phone (207) 498-6395
Other practice location 1
128 Manning Mill Rd
Hampden, ME 04444-1021
Phone (207) 498-6395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070814000332 | ME | Practitioner - Clinical Psychologist | 7810088242 | Practice locations: Bangor, ME |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
15 Cross St
Suite 20
Bangor, ME 04401-6356
Phone (207) 498-6395
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS490 | ME | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756425600000",
"number": "1700834736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 MANNING MILL RD",
"city": "HAMPDEN",
"state": "ME",
"postal_code": "044441021",
"telephone_number": "207-498-6395",
"fax_number": "855-654-1335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 CROSS ST STE 20",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016356",
"telephone_number": "207-498-6395",
"fax_number": "855-654-2335"
}
],
"practiceLocations": [
{
"address_1": "128 Manning Mill Rd",
"address_purpose": "LOCATION",
"city": "Hampden",
"state": "ME",
"postal_code": "044441021",
"country_code": "US",
"telephone_number": "207-498-6395",
"fax_number": "855-654-1335",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FREEDMAN",
"first_name": "JONATHAN",
"middle_name": "MACK",
"name_prefix": "Dr.",
"credential": "PH. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2025-08-29",
"certification_date": "2025-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": "ME",
"license": "PS490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.