Provider Demographics
NPI:1245715879
Name:FRIEDMAN, ANNIE F (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:F
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 LAUREL PARK
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1196
Mailing Address - Country:US
Mailing Address - Phone:617-244-3768
Mailing Address - Fax:
Practice Address - Street 1:EXTENDED STAY AMERICA
Practice Address - Street 2:32 4THE AVENUE
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:781-622-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1199841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA119984Other11984