Provider Demographics
NPI:1053700559
Name:FREUDENBERG, CARA MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARA
Middle Name:MICHELLE
Last Name:FREUDENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 SE ALDER STREET, STE 301
Mailing Address - Street 2:PMB #73
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4759
Mailing Address - Country:US
Mailing Address - Phone:541-321-0788
Mailing Address - Fax:541-735-9465
Practice Address - Street 1:1110 SE ALDER STREET, SUITE 301
Practice Address - Street 2:PMB #73
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4759
Practice Address - Country:US
Practice Address - Phone:541-321-0788
Practice Address - Fax:541-735-9465
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500757076Medicaid