Provider Demographics
NPI:1073598959
Name:FRIED, DOROTHY PAULETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:PAULETTE
Last Name:FRIED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DOROTHY
Other - Middle Name:PAULETTE
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCW
Mailing Address - Street 1:294 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1026
Mailing Address - Country:US
Mailing Address - Phone:516-676-1599
Mailing Address - Fax:516-671-5437
Practice Address - Street 1:174 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2024
Practice Address - Country:US
Practice Address - Phone:516-775-4258
Practice Address - Fax:516-671-5437
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03004911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N71501Medicare ID - Type Unspecified