Provider Demographics
NPI:1922368604
Name:FRIEDEN, WAYNE S (MED, CAGS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:S
Last Name:FRIEDEN
Suffix:
Gender:M
Credentials:MED, CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 DRACUT ST # 1
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3807
Mailing Address - Country:US
Mailing Address - Phone:617-909-7122
Mailing Address - Fax:
Practice Address - Street 1:175 DERBY ST STE 2
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4035
Practice Address - Country:US
Practice Address - Phone:781-749-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1719101YM0800X
MA358103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool