Provider Demographics
NPI:1639552482
Name:FRIEDMUTTER, REBECCA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:FRIEDMUTTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1088 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3234
Practice Address - Country:US
Practice Address - Phone:646-732-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY021699103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst