Provider Demographics
NPI:1619178423
Name:FRIED, SUZANNE R (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:R
Last Name:FRIED
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 PIEDMONT AVE
Mailing Address - Street 2:#123A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5221
Mailing Address - Country:US
Mailing Address - Phone:510-923-0536
Mailing Address - Fax:
Practice Address - Street 1:445 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:510-923-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist