Provider Demographics
NPI:1518042506
Name:FRIEDMAN, GEORGE JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JAY
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:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-0772
Mailing Address - Country:US
Mailing Address - Phone:808-244-5500
Mailing Address - Fax:866-288-7900
Practice Address - Street 1:33 N MARKET ST STE 205
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1742
Practice Address - Country:US
Practice Address - Phone:808-244-5500
Practice Address - Fax:866-288-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-371103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103T00000X, 103TM1800X, 103TP2701X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIR75203OtherUPIN
HI03204202Medicaid
HIH0000TCBPGMedicare PIN