Provider Demographics
NPI:1639311814
Name:LASCOUMES FRIEDMAN, JEANETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:LASCOUMES FRIEDMAN
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 1:125 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0902
Mailing Address - Country:US
Mailing Address - Phone:212-794-3890
Mailing Address - Fax:212-794-5270
Practice Address - Street 1:125 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0902
Practice Address - Country:US
Practice Address - Phone:212-794-3890
Practice Address - Fax:212-794-5270
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0740731041C0700X
NYNYSLCSW0740731041C0700X
NYNYSLCSW074073-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical