Healthcare Provider Details

I. General information

NPI: 1639552482
Provider Name (Legal Business Name): REBECCA FRIEDMUTTER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 CENTRAL PARK AVE SUITE 224
SCARSDALE NY
10583-3234
US

IV. Provider business mailing address

1088 CENTRAL PARK AVE SUITE 224
SCARSDALE NY
10583-3234
US

V. Phone/Fax

Practice location:
  • Phone: 646-732-6266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number021699
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: