Provider Demographics
NPI:1659382182
Name:JEFFREY FRIEDMAN, PHD, PSYCHOLOGIST, INC
Entity Type:Organization
Organization Name:JEFFREY FRIEDMAN, PHD, PSYCHOLOGIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-545-9410
Mailing Address - Street 1:1015 NIPOMO ST
Mailing Address - Street 2:STE 230
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3874
Mailing Address - Country:US
Mailing Address - Phone:805-545-9410
Mailing Address - Fax:805-545-9476
Practice Address - Street 1:956 WALNUT ST STE 20
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-1707
Practice Address - Country:US
Practice Address - Phone:805-545-9410
Practice Address - Fax:805-545-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9763Medicare PIN