Provider Demographics
NPI:1700188547
Name:FRIEDMAN, JOSEPH ELI
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ELI
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 COWELL BLVD
Mailing Address - Street 2:APT # 5
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4313
Mailing Address - Country:US
Mailing Address - Phone:530-574-5308
Mailing Address - Fax:
Practice Address - Street 1:4141 COWELL BLVD
Practice Address - Street 2:APT # 5
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4313
Practice Address - Country:US
Practice Address - Phone:530-574-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical