Provider Demographics
NPI:1417978123
Name:FRYDMAN, DAN S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:S
Last Name:FRYDMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 FRANCIS
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST JOSPEH
Mailing Address - State:MO
Mailing Address - Zip Code:64501
Mailing Address - Country:US
Mailing Address - Phone:816-364-1501
Mailing Address - Fax:816-364-6735
Practice Address - Street 1:510 FRANCIS
Practice Address - Street 2:SUITE 200
Practice Address - City:ST JOSPEH
Practice Address - State:MO
Practice Address - Zip Code:64501
Practice Address - Country:US
Practice Address - Phone:816-364-1501
Practice Address - Fax:816-364-6735
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003027104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS940000Medicare ID - Type UnspecifiedGROUP