Provider Demographics
NPI:1346350600
Name:FREID, JOEL BENJAMIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BENJAMIN
Last Name:FREID
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 1:5925 IMPERIAL PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-8476
Mailing Address - Country:US
Mailing Address - Phone:863-644-0506
Mailing Address - Fax:863-644-7522
Practice Address - Street 1:5925 IMPERIAL PKWY
Practice Address - Street 2:SUITE 128
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-8476
Practice Address - Country:US
Practice Address - Phone:863-644-0506
Practice Address - Fax:863-644-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 0002213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74164Medicare ID - Type Unspecified