Provider Demographics
NPI:1336614585
Name:OMEZI, FRIEDA ROSEANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:FRIEDA
Middle Name:ROSEANNA
Last Name:OMEZI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:FRIEDA
Other - Middle Name:R
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 ROCKMART AVE # PVH
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1732
Mailing Address - Country:US
Mailing Address - Phone:516-865-2301
Mailing Address - Fax:
Practice Address - Street 1:176 ROCKMART AVE # PVH
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1732
Practice Address - Country:US
Practice Address - Phone:516-865-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0771761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical