Provider Demographics
NPI:1104204791
Name:FRIEDMAN, BARRY (LICSW)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ENGLEWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7864
Mailing Address - Country:US
Mailing Address - Phone:617-232-4771
Mailing Address - Fax:
Practice Address - Street 1:39 ENGLEWOOD AVE APT 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7864
Practice Address - Country:US
Practice Address - Phone:617-232-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10174821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical