Provider Demographics
NPI:1497034805
Name:FRIEDMAN, THEODORE E (LCSW)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:E
Last Name:FRIEDMAN
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 1:7136 MURRAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2938
Mailing Address - Country:US
Mailing Address - Phone:619-729-8547
Mailing Address - Fax:619-881-0088
Practice Address - Street 1:5575 LAKE PARK WAY
Practice Address - Street 2:SUITE 100 UNIT 1
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1664
Practice Address - Country:US
Practice Address - Phone:619-729-8547
Practice Address - Fax:619-881-0088
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical