Provider Demographics
NPI:1770555989
Name:FRIEDRICH, ROBERT A (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:FRIEDRICH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TICHENOR PL
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2428
Mailing Address - Country:US
Mailing Address - Phone:917-940-1007
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY
Practice Address - Street 2:SUITE 1205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2007
Practice Address - Country:US
Practice Address - Phone:917-940-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05393400OtherNEW JERSEY LICENSE
NY11709203OtherCAQH
NY11709203OtherCAQH