Basic Information
| Provider Information | |||||||||
| NPI: | 1013334630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIEDLAND | ||||||||
| FirstName: | MARKETA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | FRIEDLAND | ||||||||
| OtherFirstName: | MARKETA | ||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 107 E 102ND ST | ||||||||
| Address2: | APT. 2D | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100295759 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2090 ADAM CLAYTON BOULEVARD | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125536708 | ||||||||
| FaxNumber: | 2122222318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2014 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 081946-1 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | P95955 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 083298-01 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.