Provider Demographics
NPI:1093878704
Name:FRIEDBERG, DOROTHY L (RO36575-1)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:L
Last Name:FRIEDBERG
Suffix:
Gender:F
Credentials:RO36575-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 BROADWAY
Mailing Address - Street 2:SUITE 901
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4720
Mailing Address - Country:US
Mailing Address - Phone:212-460-5441
Mailing Address - Fax:718-872-5615
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:SUITE 901
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4703
Practice Address - Country:US
Practice Address - Phone:212-460-5441
Practice Address - Fax:718-872-5615
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO36575-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN79702Medicare ID - Type Unspecified