Provider Demographics
NPI:1780914127
Name:FRIEDMAN, MARGO (MA, LPC, LADC, CCDP)
Entity type:Individual
Prefix:MS
First Name:MARGO
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MA, LPC, LADC, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 EDISON RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4312
Mailing Address - Country:US
Mailing Address - Phone:203-521-9241
Mailing Address - Fax:
Practice Address - Street 1:4 WHITNEY STREET EXT
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3768
Practice Address - Country:US
Practice Address - Phone:203-521-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001492101YP2500X
CT000950101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008038038Medicaid
CT008038038Medicaid
CT004041000Medicaid