Provider Demographics
NPI:1598875429
Name:FRIEDBERG, JACQUELINE SUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SUE
Last Name:FRIEDBERG
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 1:550 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5013
Mailing Address - Country:US
Mailing Address - Phone:516-795-2026
Mailing Address - Fax:516-795-2026
Practice Address - Street 1:550 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5013
Practice Address - Country:US
Practice Address - Phone:516-795-2026
Practice Address - Fax:516-795-2026
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
NYR031689-1102L00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY066885OtherEMPIRE/VALUE OPTIONS/OPTIMUM
7800008OtherGHI
P12268310OtherMULTIPLAN
4387OtherAFFINITY
60106OtherVETRA
FI1689OtherATLANTIC HEALTH CARE
T166854OtherCIGNA
066885OtherEMPIRE VALUE OPTIONS
NY0189236OtherGHI
208916624OtherUNITED BEHAVIORAL HEALTH CARE
305969AOtherMAGNACARE
55247OtherHIP
P3179295OtherOXFORD
1061760OtherBEACON
NY208916624OtherUNITED HEALTHCARE
NY7759668OtherAETNA
3795OtherCMS
NYN38Q71Medicare ID - Type Unspecified