Healthcare Provider Details

I. General information

NPI: 1396403150
Provider Name (Legal Business Name): CARLY MARIE FRIEDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10038 MEADOW WAY UNIT D
TRUCKEE CA
96161-4974
US

IV. Provider business mailing address

250 W ARROYO ST # 1
RENO NV
89509-2720
US

V. Phone/Fax

Practice location:
  • Phone: 530-426-2110
  • Fax:
Mailing address:
  • Phone: 916-261-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4531
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: