Healthcare Provider Details

I. General information

NPI: 1619168085
Provider Name (Legal Business Name): DARON V FRIEDMAN MA. LCMHC.LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAIN ST STE 4
KEENE NH
03431-3715
US

IV. Provider business mailing address

39 CENTRAL SQ STE 281
KEENE NH
03431-3703
US

V. Phone/Fax

Practice location:
  • Phone: 603-762-0268
  • Fax:
Mailing address:
  • Phone: 603-762-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number585
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number200
License Number StateNH

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: