Provider Demographics
NPI:1417160029
Name:FRIEDMAN, MARC JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JAY
Last Name:FRIEDMAN
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 1:47 CALAIS RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2803
Mailing Address - Country:US
Mailing Address - Phone:973-895-5052
Mailing Address - Fax:973-895-5052
Practice Address - Street 1:47 CALAIS RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2803
Practice Address - Country:US
Practice Address - Phone:973-895-5052
Practice Address - Fax:973-895-5052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00146200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical