Provider Demographics
NPI:1629213251
Name:FRIED, ELIZABETH (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 TYLER AVE APT 2204
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2965
Mailing Address - Country:US
Mailing Address - Phone:732-596-1496
Mailing Address - Fax:877-645-1399
Practice Address - Street 1:4300 HYLAN BLVD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6505
Practice Address - Country:US
Practice Address - Phone:718-605-0642
Practice Address - Fax:718-984-9620
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-06-2803103K00000X
NY012367-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst