Provider Demographics
NPI:1104400639
Name:FRIEDRICH, IAN WILLIAM THOMSON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:WILLIAM THOMSON
Last Name:FRIEDRICH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1499
Mailing Address - Country:US
Mailing Address - Phone:860-245-1484
Mailing Address - Fax:
Practice Address - Street 1:846 FARMINGTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1554
Practice Address - Country:US
Practice Address - Phone:860-530-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11770104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker