Provider Demographics
NPI:1881790590
Name:FREEDLE, LORRAINE R (PHD, LISW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:R
Last Name:FREEDLE
Suffix:
Gender:F
Credentials:PHD, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4249
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-0249
Mailing Address - Country:US
Mailing Address - Phone:808-345-1726
Mailing Address - Fax:808-315-7204
Practice Address - Street 1:25 KAHOA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2205
Practice Address - Country:US
Practice Address - Phone:808-345-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA-0938103G00000X
HIPSY-1150103G00000X
NMI-21451041C0700X
HILCSW-39801041C0700X
NM1037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical