Healthcare Provider Details

I. General information

NPI: 1710473863
Provider Name (Legal Business Name): FRIEDMANN THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SOVEREIGN CT STE 103
BALLWIN MO
63011-4435
US

IV. Provider business mailing address

301 SOVEREIGN CT STE 103
BALLWIN MO
63011-4435
US

V. Phone/Fax

Practice location:
  • Phone: 636-548-0588
  • Fax:
Mailing address:
  • Phone: 636-548-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017014252
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GENEVIEVE FRIEDMANN
Title or Position: OWNER
Credential: LCSW
Phone: 636-548-0588