Provider Demographics
NPI:1083081178
Name:FRIEDMAN, MARY LOU (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CLINTON AVE # 3N
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3189
Mailing Address - Country:US
Mailing Address - Phone:708-638-0978
Mailing Address - Fax:
Practice Address - Street 1:1103 WESTGATE ST STE 200
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1022
Practice Address - Country:US
Practice Address - Phone:708-638-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist