Healthcare Provider Details

I. General information

NPI: 1043134935
Provider Name (Legal Business Name): AMY ELZA FRIEDMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 BROADWAY STE 205
KINGSTON NY
12401-5159
US

IV. Provider business mailing address

15 FORTUNE RD W
SCOTCHTOWN NY
10941-1625
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-2266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: