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General NPI Number Information
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NPI Number | 1609931955
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Entity Type | Organization
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Legal Business Name | JOEL B FREID PHD PA
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2020 W LAKE PARKER DR
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City | LAKELAND
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State | FL
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Zip | 33805-5005
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Country | US
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Telephone | 863-682-7580
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Fax | 863-683-9564
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Provider Business Mailing Address
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Address Line | 5925 IMPERIAL PKWY SUITE 128
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City | MULBERRY
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State | FL
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Zip | 33860-8476
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Country | US
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Telephone | 863-644-0506
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Fax | 863-644-7522
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL BENJAMIN FREID
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Credential | PH.D.
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Telephone | 863-644-0506
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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 0002213
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License Number State | FL
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