Provider Demographics
NPI:1760575401
Name:FRIEDMAN, CLYDE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 WALT WHITMAN RD STE 124
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4149
Mailing Address - Country:US
Mailing Address - Phone:631-423-0188
Mailing Address - Fax:
Practice Address - Street 1:33 S. SERVICE ROAD
Practice Address - Street 2:STE. 189
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1036
Practice Address - Country:US
Practice Address - Phone:631-423-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR014156-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN03051Medicare PIN