Provider Demographics
NPI:1134229792
Name:FRIEDMAN, CLARE TAYLOR (PHD)
Entity type:Individual
Prefix:DR
First Name:CLARE
Middle Name:TAYLOR
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 MT DIABLO BLVD STE B203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-7120
Mailing Address - Country:US
Mailing Address - Phone:925-631-1669
Mailing Address - Fax:925-377-9618
Practice Address - Street 1:3468 MT DIABLO BLVD STE B203
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-7120
Practice Address - Country:US
Practice Address - Phone:925-631-1669
Practice Address - Fax:925-377-9618
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY147400OtherMEDI-CAL
CAPSY147400OtherMEDI-CAL
CAQ55636Medicare UPIN