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NPI Code Detail

MEDICARE: STACEY MICHELE FRIED L.C.S.W

MEDICARE: STACEY MICHELE FRIED L.C.S.W
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker062300NY
21041C0700XClinical Social Worker44SC05289000NJ

General Provider Information

NPI Number : 1275509556
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY MICHELE FRIED L.C.S.W
Provider Business Mailing Address
First Line : 87 BEACON PL
Second Line :
City : ROBBINSVILLE
State : NJ
Zip : 08691-3031
Country : US
Telephone Number : 917-992-0664
Fax Number :
Provider Business Practice Location Address
First Line : 201 BRYSON AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-1922
Country : US
Telephone Number : 718-815-8489
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 07/08/2007

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Directions to “ STACEY MICHELE FRIED L.C.S.W” Practice Location

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