Provider Demographics
NPI:1447229539
Name:FRIED, ERNEST S (PHD; LCSW)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:S
Last Name:FRIED
Suffix:
Gender:M
Credentials:PHD; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PIERREPONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2452
Mailing Address - Country:US
Mailing Address - Phone:718-624-6507
Mailing Address - Fax:718-852-7124
Practice Address - Street 1:62 PIERREPONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2452
Practice Address - Country:US
Practice Address - Phone:718-624-6507
Practice Address - Fax:718-852-7124
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPROOO980-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN53411Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER