Provider Demographics
NPI:1275521866
Name:FRIEDMUTTER, MARTIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:FRIEDMUTTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BELL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2097
Mailing Address - Country:US
Mailing Address - Phone:347-323-5331
Mailing Address - Fax:
Practice Address - Street 1:3635 BELL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2097
Practice Address - Country:US
Practice Address - Phone:347-323-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist