Provider Demographics
NPI:1902411184
Name:FRIEDMAN, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
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 1:31 E VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1338
Mailing Address - Country:US
Mailing Address - Phone:844-546-1212
Mailing Address - Fax:
Practice Address - Street 1:19609 S MCQUEEN RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1903
Practice Address - Country:US
Practice Address - Phone:623-850-5400
Practice Address - Fax:623-321-7850
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician