Provider Demographics
NPI:1750547899
Name:FRIEDMAN, ELLEN GRACE (L,CSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:GRACE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:L,CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W 18TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4424
Mailing Address - Country:US
Mailing Address - Phone:917-921-2620
Mailing Address - Fax:
Practice Address - Street 1:305 W 18TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4424
Practice Address - Country:US
Practice Address - Phone:917-921-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR014158-1101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331825Medicare Oscar/Certification
NY331825Medicare Oscar/Certification