Provider Demographics
NPI:1417923285
Name:FRIEDMAN, LARRY STEPHEN (PHD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:STEPHEN
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 1:921 SW WASHINGTON
Mailing Address - Street 2:STE 814
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2826
Mailing Address - Country:US
Mailing Address - Phone:503-223-5441
Mailing Address - Fax:503-221-4277
Practice Address - Street 1:921 SW WASHINGTON
Practice Address - Street 2:STE 814
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2826
Practice Address - Country:US
Practice Address - Phone:503-223-5441
Practice Address - Fax:503-221-4277
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR675103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR152975Medicaid
0000TCGZGMedicare ID - Type Unspecified