Provider Demographics
NPI:1669646659
Name:WESTFRIED, ERIC MASON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MASON
Last Name:WESTFRIED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 GOLD AVE SW
Mailing Address - Street 2:SUITE #202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3300
Mailing Address - Country:US
Mailing Address - Phone:505-242-4401
Mailing Address - Fax:505-243-2776
Practice Address - Street 1:215 GOLD AVE SW
Practice Address - Street 2:SUITE #202
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3300
Practice Address - Country:US
Practice Address - Phone:505-242-4401
Practice Address - Fax:505-243-2776
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM641103G00000X
CO1943103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM337229601OtherMEDICARE, PART B