Provider Demographics
NPI:1316035975
Name:FRIEDEN, FREDRICK P (PHD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:P
Last Name:FRIEDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12695 MCMANUS BLVD.
Mailing Address - Street 2:BLDG 8
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4442
Mailing Address - Country:US
Mailing Address - Phone:757-877-7700
Mailing Address - Fax:757-872-7211
Practice Address - Street 1:12695 MCMANUS BLVD.
Practice Address - Street 2:BLDG 8
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4442
Practice Address - Country:US
Practice Address - Phone:757-877-7700
Practice Address - Fax:757-872-7211
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA77 36 68 1Medicaid
R 60668Medicare UPIN
68 00 00 288Medicare ID - Type Unspecified