Provider Demographics
NPI:1265933188
Name:FRIEDMAN, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1105
Mailing Address - Country:US
Mailing Address - Phone:484-403-0790
Mailing Address - Fax:
Practice Address - Street 1:2109 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1105
Practice Address - Country:US
Practice Address - Phone:484-403-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2024-03-27
Deactivation Date:2019-12-04
Deactivation Code:
Reactivation Date:2021-02-03
Provider Licenses
StateLicense IDTaxonomies
PABH004817103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst