Provider Demographics
NPI:1275882714
Name:FRIEDMAN, JACQUELINE BESS (PSYD)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:BESS
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 71ST ST
Mailing Address - Street 2:4G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5130
Mailing Address - Country:US
Mailing Address - Phone:917-855-1891
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY
Practice Address - Street 2:SUITE 900 EAST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4201
Practice Address - Country:US
Practice Address - Phone:917-855-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical