Provider Demographics
NPI:1912508938
Name:MELISSA FRIEDER, LLC
Entity Type:Organization
Organization Name:MELISSA FRIEDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-987-6321
Mailing Address - Street 1:8335 SW 107TH AVE # 367
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3817
Mailing Address - Country:US
Mailing Address - Phone:305-987-6321
Mailing Address - Fax:
Practice Address - Street 1:7001 SW 97TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1407
Practice Address - Country:US
Practice Address - Phone:305-987-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)