Provider Demographics
NPI:1952484248
Name:FRIEDMAN, SHARON ANN (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:ANN
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:6809 COLONEL HOLCUMB DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012
Mailing Address - Country:US
Mailing Address - Phone:847-274-3910
Mailing Address - Fax:847-934-1550
Practice Address - Street 1:645 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-2922
Practice Address - Country:US
Practice Address - Phone:815-337-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005534103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL625330Medicare ID - Type Unspecified