MEDICARE: ROCHELLE FRIED LCSW

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	1041C0700X	Clinical Social Worker	LCS12445	CA

General Provider Information

NPI Number	:	1548422520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCHELLE FRIED LCSW

Provider Business Mailing Address
First Line	:	3815 ATLANTIC AVE STE 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3500
Country	:	US
Telephone Number	:	323-833-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 ATLANTIC AVE STE 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3500
Country	:	US
Telephone Number	:	323-833-3636
Fax Number	:

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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