Provider Demographics
NPI:1740832054
Name:FRIEDMAN, BLIMIE (MS ED BCBA)
Entity type:Individual
Prefix:MRS
First Name:BLIMIE
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MS ED BCBA
Other - Prefix:
Other - First Name:BLIMIE
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4A EDEN CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1495
Mailing Address - Country:US
Mailing Address - Phone:718-288-1160
Mailing Address - Fax:
Practice Address - Street 1:4A EDEN CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1495
Practice Address - Country:US
Practice Address - Phone:718-288-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11936959103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst