Provider Demographics
NPI:1750337424
Name:FREIDENBERGS, INGRID (PHD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:FREIDENBERGS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 29TH ST
Mailing Address - Street 2:27C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8173
Mailing Address - Country:US
Mailing Address - Phone:212-263-6165
Mailing Address - Fax:
Practice Address - Street 1:31 W 10TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8738
Practice Address - Country:US
Practice Address - Phone:212-263-6165
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004981103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR51081Medicare UPIN
NYV13611Medicare ID - Type Unspecified