Healthcare Provider Details

I. General information

NPI: 1922368604
Provider Name (Legal Business Name): WAYNE S. FRIEDEN M.ED., CAGS, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY ST STE 2
HINGHAM MA
02043-4035
US

IV. Provider business mailing address

60 DRACUT ST # 1
DORCHESTER MA
02124-3807
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-9227
  • Fax:
Mailing address:
  • Phone: 617-909-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1719
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number358
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: