Provider Demographics
NPI:1093363210
Name:FREIDENRICH, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FREIDENRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 WYCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2356
Mailing Address - Country:US
Mailing Address - Phone:908-507-8391
Mailing Address - Fax:
Practice Address - Street 1:1051 WYCHWOOD RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2356
Practice Address - Country:US
Practice Address - Phone:908-507-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062840001041C0700X
101Y00000X, 247000000X, 390200000X
44SC062840001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program