Provider Demographics
NPI:1497834154
Name:FRIEDMAN, LISA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:FRIEDMAN
Other - Last Name:JABICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:9715 W. BROWARD BLVD.
Mailing Address - Street 2:P.M. BOX 148
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2351
Mailing Address - Country:US
Mailing Address - Phone:954-741-1099
Mailing Address - Fax:954-585-0177
Practice Address - Street 1:7376 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1605
Practice Address - Country:US
Practice Address - Phone:954-741-1099
Practice Address - Fax:954-585-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9050Medicare ID - Type UnspecifiedPSYCHOTHERAPY