Provider Demographics
NPI:1598054827
Name:FRIED, KENNETH BRIAN (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRIAN
Last Name:FRIED
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PALOMAR AIRPORT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1027
Mailing Address - Country:US
Mailing Address - Phone:714-955-7118
Mailing Address - Fax:760-931-4850
Practice Address - Street 1:701 PALOMAR AIRPORT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1027
Practice Address - Country:US
Practice Address - Phone:714-955-7118
Practice Address - Fax:760-931-4850
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMC 23619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist