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General NPI Number Information
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NPI Number | 1053550103
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Entity Type | Organization
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Legal Business Name | WILLIAM P FRIEDENBERG PHD
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 403 N WILD OLIVE AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-3937
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Country | US
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Telephone | 386-253-2531
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Fax | 386-253-6144
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Provider Business Mailing Address
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Address Line | 403 N WILD OLIVE AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-3937
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Country | US
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Telephone | 386-253-2531
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Fax | 386-253-6144
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM PAUL FRIEDENBERG
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Credential | PH.D.
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Telephone | 386-253-2531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 2214
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License Number State | FL
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