1659382182 NPI number — JEFFREY FRIEDMAN, PHD, PSYCHOLOGIST, INC

Table of content: (NPI 1659382182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659382182 NPI number — JEFFREY FRIEDMAN, PHD, PSYCHOLOGIST, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY FRIEDMAN, PHD, PSYCHOLOGIST, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1659382182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 NIPOMO ST
Provider Second Line Business Mailing Address:
STE 230
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-3874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-545-9410
Provider Business Mailing Address Fax Number:
805-545-9476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
956 WALNUT ST STE 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-545-9410
Provider Business Practice Location Address Fax Number:
805-545-9476
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-545-9410

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY9763 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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