Provider Demographics
NPI:1619950300
Name:FRIEDMAN, DAGMAR B (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DAGMAR
Middle Name:B
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WEST ST
Mailing Address - Street 2:#22
Mailing Address - City:BEVERLY FARMS
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2225
Mailing Address - Country:US
Mailing Address - Phone:978-927-3232
Mailing Address - Fax:978-927-3506
Practice Address - Street 1:45 WEST ST
Practice Address - Street 2:#22
Practice Address - City:BEVERLY FARMS
Practice Address - State:MA
Practice Address - Zip Code:01915-2225
Practice Address - Country:US
Practice Address - Phone:978-927-3232
Practice Address - Fax:978-927-3506
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4862Medicare PIN