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General NPI Number Information
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NPI Number | 1457404113
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Entity Type | Individual
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Provider Name | JONATHAN FRIEDMAN M.A.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 734 10TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92101-6502
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Country | US
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Telephone | 619-239-4663
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-6050
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Fax | 239-343-6051
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY12323
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY12323
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License Number State | FL
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