Provider Demographics
NPI:1558365023
Name:FRIEDLAND-PEREZ, DAWN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:FRIEDLAND-PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WOODSTORK DR
Mailing Address - Street 2:
Mailing Address - City:MT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-3400
Mailing Address - Country:US
Mailing Address - Phone:631-331-2690
Mailing Address - Fax:
Practice Address - Street 1:8 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3337
Practice Address - Country:US
Practice Address - Phone:631-736-7707
Practice Address - Fax:631-736-7767
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-12
Last Update Date:2024-01-31
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
NYR054870-11041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02532887Medicaid
NYP00153317Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
NY02532887Medicaid
NY02532887Medicaid