Healthcare Provider Details

I. General information

NPI: 1053486142
Provider Name (Legal Business Name): LARRY MARK FRIEDBERG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31600 TELEGRAPH ROAD SUITE 250
BINGHAM FARMS MI
48025-4372
US

IV. Provider business mailing address

31600 TELEGRAPH ROAD SUITE 250
BINGHAM FARMS MI
48025-4372
US

V. Phone/Fax

Practice location:
  • Phone: 248-965-9532
  • Fax: 248-671-3203
Mailing address:
  • Phone: 248-965-9532
  • Fax: 248-671-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301005034
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number6301005034
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number6301005034
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301005034
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301005034
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301005034
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: