Provider Demographics
NPI:1235300070
Name:FRIEDEL, DOLORES ENID
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:ENID
Last Name:FRIEDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:ENID
Other - Last Name:ETROG-FRIEDEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:70 ITHACA AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1321
Mailing Address - Country:US
Mailing Address - Phone:516-239-3411
Mailing Address - Fax:516-239-6464
Practice Address - Street 1:70 ITHACA AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11509-1321
Practice Address - Country:US
Practice Address - Phone:516-239-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO12609-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical