1073598959 NPI number — MS. DOROTHY PAULETTE FRIED LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073598959 NPI number — MS. DOROTHY PAULETTE FRIED LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIED
Provider First Name:
DOROTHY
Provider Middle Name:
PAULETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLDSTEIN
Provider Other First Name:
DOROTHY
Provider Other Middle Name:
PAULETTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSCW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073598959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
294 PROSPECT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEA CLIFF
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11579-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-676-1599
Provider Business Mailing Address Fax Number:
516-671-5437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 JERICHO TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORAL PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11001-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-775-4258
Provider Business Practice Location Address Fax Number:
516-671-5437
Provider Enumeration Date:
12/13/2005

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: 1041C0700X , with the licence number:  0300491 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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