Provider Demographics
NPI:1093236531
Name:FRIEDMAN, LEAH F (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:F
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 MARSH LANDING BLVD APT 112
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2473
Mailing Address - Country:US
Mailing Address - Phone:904-710-2588
Mailing Address - Fax:
Practice Address - Street 1:2170 S PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5734
Practice Address - Country:US
Practice Address - Phone:720-706-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1132485171174400000X
FL1-17-28115103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1132485171OtherSTUDENTS WITH DISABILITIES (BIRTH - GRADE 2), INITIAL CERTIFICATE