MEDICARE: FRIEDMANN THERAPY, LLC

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	2017014252	MO

General Provider Information

NPI Number	:	1710473863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIEDMANN THERAPY, LLC

Provider Business Mailing Address
First Line	:	301 SOVEREIGN CT STE 103
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4435
Country	:	US
Telephone Number	:	636-548-0588
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 SOVEREIGN CT STE 103
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4435
Country	:	US
Telephone Number	:	636-548-0588
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GENEVIEVE FRIEDMANN
Credential	:	LCSW
Telephone Number	:	636-548-0588

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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