Provider Demographics
NPI:1639227747
Name:FRIEDMAN, MAUD (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MAUD
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 84TH ST
Mailing Address - Street 2:24A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6268
Mailing Address - Country:US
Mailing Address - Phone:212-879-2714
Mailing Address - Fax:212-288-3704
Practice Address - Street 1:401 E 84TH ST
Practice Address - Street 2:24A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-6268
Practice Address - Country:US
Practice Address - Phone:212-879-2714
Practice Address - Fax:212-288-3704
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043136-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4711Medicare ID - Type Unspecified
S72620Medicare UPIN