Healthcare Provider Details

I. General information

NPI: 1750749834
Provider Name (Legal Business Name): YEHUDIS FRIEDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 06/23/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ROUTE 35
WALL TOWNSHIP NJ
07719-3530
US

IV. Provider business mailing address

35 LEWIN AVE
LAKEWOOD NJ
08701-4674
US

V. Phone/Fax

Practice location:
  • Phone: 732-814-4648
  • Fax: 609-225-9355
Mailing address:
  • Phone: 773-503-9132
  • Fax: 609-225-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06342800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: