Healthcare Provider Details

I. General information

NPI: 1780914127
Provider Name (Legal Business Name): MARGO FRIEDMAN MA, LPC, LADC, CCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WHITNEY STREET EXT
WESTPORT CT
06880-3768
US

IV. Provider business mailing address

256 EDISON RD
TRUMBULL CT
06611-4312
US

V. Phone/Fax

Practice location:
  • Phone: 203-521-9241
  • Fax:
Mailing address:
  • Phone: 203-521-9241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000950
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001492
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: