Provider Demographics
NPI:1083882344
Name:SANDE-FRIEDMAN, MARILYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:SANDE-FRIEDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:SANDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1123 PARK AVE.
Mailing Address - Street 2:1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1241
Mailing Address - Country:US
Mailing Address - Phone:212-289-2435
Mailing Address - Fax:212-289-7626
Practice Address - Street 1:1123 PARK AVE.
Practice Address - Street 2:1D
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10128-1241
Practice Address - Country:US
Practice Address - Phone:212-289-2435
Practice Address - Fax:212-289-7626
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013009-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN27791Medicare PIN