Provider Demographics
NPI:1205071438
Name:FRIEDMAN, MICHAEL C (MA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-855 IWALANI PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9650
Mailing Address - Country:US
Mailing Address - Phone:503-753-9938
Mailing Address - Fax:
Practice Address - Street 1:73-5618 MAIAU ST STE B201
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2635
Practice Address - Country:US
Practice Address - Phone:503-753-9938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00059911101YM0800X
WALH60746917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health