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General NPI Number Information
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NPI Number | 1104178235
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Entity Type | Individual
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Provider Name | ROBERT FRIEDMAN
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Gender | Male
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Dates
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Enumeration Date | 10/13/2012
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Last Update Date | 10/13/2012
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Provider Practice Location Address
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Address Line | 30 ORANGE RD
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2110
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Country | US
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Telephone | 973-744-6524
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Fax |
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Provider Business Mailing Address
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Address Line | 74 PLEASANT AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3114
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Country | US
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Telephone | 973-641-1553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05438100
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License Number State | NJ
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