Provider Demographics
NPI:1083191118
Name:FRIDMAN, MARY SARA (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SARA
Last Name:FRIDMAN
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3376 S EASTERN AVE STE 186
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3385
Mailing Address - Country:US
Mailing Address - Phone:702-490-9009
Mailing Address - Fax:
Practice Address - Street 1:4170 S DECATUR BLVD STE C1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5863
Practice Address - Country:US
Practice Address - Phone:702-659-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10743-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical