Provider Demographics
NPI:1558759035
Name:FREIDENBERG, BRIAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:FREIDENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:255 ORANGE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2400
Mailing Address - Country:US
Mailing Address - Phone:518-729-2126
Mailing Address - Fax:518-729-2127
Practice Address - Street 1:255 ORANGE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-2400
Practice Address - Country:US
Practice Address - Phone:518-729-2126
Practice Address - Fax:518-729-2127
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY68 017247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY68 017247OtherUNIVERSITY OF THE STATE OF NY EDUCATION DEPARTMENT OFFICE OF THE PROFESSIONS