MEDICARE: MS. AMANDA JOY FRIEDMAN MSED, SBL

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
1	103K00000X	Behavior Analyst	663593	NY

General Provider Information

NPI Number	:	1336564012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA JOY FRIEDMAN MSED, SBL

Provider Business Mailing Address
First Line	:	164 W 25TH
Second Line	:	SUITE 7R
City	:	NY
State	:	NY
Zip	:	10001
Country	:	US
Telephone Number	:	212-256-0846
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 W 25TH ST
Second Line	:	SUITE 7R
City	:	NEW YORK
State	:	NY
Zip	:	10001-7400
Country	:	US
Telephone Number	:	212-256-0846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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