Provider Demographics
NPI:1255765160
Name:FRIEDBERG, TRUDY (PC)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:FRIEDBERG
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:
Other - Last Name:ROSENSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 LEBANON RD STE 3B
Mailing Address - Street 2:
Mailing Address - City:BOZRAH
Mailing Address - State:CT
Mailing Address - Zip Code:06334-1116
Mailing Address - Country:US
Mailing Address - Phone:860-886-8122
Mailing Address - Fax:
Practice Address - Street 1:46 LEBANON RD # 3B
Practice Address - Street 2:
Practice Address - City:BOZRAH
Practice Address - State:CT
Practice Address - Zip Code:06334-1116
Practice Address - Country:US
Practice Address - Phone:860-861-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
101YP2500XOtherTAXONOMY