Provider Demographics
NPI:1700522828
Name:FRIED, AHUVAH BRACHA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:AHUVAH
Middle Name:BRACHA
Last Name:FRIED
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5241
Mailing Address - Country:US
Mailing Address - Phone:201-880-7530
Mailing Address - Fax:201-880-7529
Practice Address - Street 1:6 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5241
Practice Address - Country:US
Practice Address - Phone:201-880-7530
Practice Address - Fax:201-880-7529
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06589500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20619745OtherINSURANCE