Provider Demographics
NPI:1205977956
Name:FRIEDMAN, JOHN W (EDD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1002
Mailing Address - Country:US
Mailing Address - Phone:617-965-1618
Mailing Address - Fax:
Practice Address - Street 1:126 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1002
Practice Address - Country:US
Practice Address - Phone:617-965-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2094103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist