1316085673 NPI number — MR. ADAM DEREK FRIEDMAN MS, LMHC

Table of content: MR. ADAM DEREK FRIEDMAN MS, LMHC (NPI 1316085673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316085673 NPI number — MR. ADAM DEREK FRIEDMAN MS, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
ADAM
Provider Middle Name:
DEREK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316085673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUZZARDS BAY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02532-3229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-836-3738
Provider Business Mailing Address Fax Number:
558-590-1219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOURNE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02532-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-836-3738
Provider Business Practice Location Address Fax Number:
774-836-3738
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6174 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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