Healthcare Provider Details

I. General information

NPI: 1801758396
Provider Name (Legal Business Name): MARK FRIEDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 TEHAMA ST
BROOKLYN NY
11218-2111
US

IV. Provider business mailing address

83 TEHAMA ST
BROOKLYN NY
11218-2111
US

V. Phone/Fax

Practice location:
  • Phone: 917-660-4602
  • Fax:
Mailing address:
  • Phone: 917-660-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP140011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: