Provider Demographics
NPI:1275732547
Name:FRIEDMAN, IRIS JILL (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:JILL
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2803
Mailing Address - Country:US
Mailing Address - Phone:516-781-7500
Mailing Address - Fax:
Practice Address - Street 1:3394 MERRICK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2803
Practice Address - Country:US
Practice Address - Phone:516-781-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0402191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN96701Medicare PIN